Provider Demographics
NPI:1699832337
Name:FISHER, BILL LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:LEE
Last Name:FISHER
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 1:1009 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2830
Mailing Address - Country:US
Mailing Address - Phone:580-225-2030
Mailing Address - Fax:580-225-0603
Practice Address - Street 1:1009 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2830
Practice Address - Country:US
Practice Address - Phone:580-225-2030
Practice Address - Fax:580-225-0603
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQDCGNMedicare ID - Type Unspecified