Provider Demographics
NPI:1730142852
Name:FISHER, JAMES H (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
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 1:1004 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-985-1344
Mailing Address - Fax:215-985-1434
Practice Address - Street 1:1004 PINE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-985-1344
Practice Address - Fax:215-985-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002920-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01075866Medicaid
PAU24388Medicare UPIN
PA01075866Medicaid