Provider Demographics
NPI:1710320676
Name:FISCHER, JEREMY SHIMON (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SHIMON
Last Name:FISCHER
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7314 VISTA DEL MAR LN
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7653
Mailing Address - Country:US
Mailing Address - Phone:424-278-4325
Mailing Address - Fax:
Practice Address - Street 1:7314 VISTA DEL MAR LN
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7653
Practice Address - Country:US
Practice Address - Phone:424-278-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
CAND-570175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist