Provider Demographics
NPI:1750501722
Name:FIDLER, JOHN PERRY (DC CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PERRY
Last Name:FIDLER
Suffix:
Gender:M
Credentials:DC CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 US HWY 105 S
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28679
Mailing Address - Country:US
Mailing Address - Phone:828-264-1561
Mailing Address - Fax:828-264-1560
Practice Address - Street 1:2301 US HWY 105 S
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28679
Practice Address - Country:US
Practice Address - Phone:828-264-1561
Practice Address - Fax:828-264-1560
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001376959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08409OtherSTATE PLAN
244388Medicare ID - Type Unspecified
T64434Medicare UPIN