Provider Demographics
NPI:1669676656
Name:FISCHER, BRENT JAMES (DC)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:JAMES
Last Name:FISCHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 NC HWY 16 SOUTH
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-9985
Mailing Address - Country:US
Mailing Address - Phone:828-632-5100
Mailing Address - Fax:828-632-5106
Practice Address - Street 1:663 NC HWY 16 SOUTH
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-9985
Practice Address - Country:US
Practice Address - Phone:828-632-5100
Practice Address - Fax:828-632-5106
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08404OtherBCBS NC
NC8908404Medicaid
T64273Medicare UPIN
NC08404OtherBCBS NC