Provider Demographics
NPI:1760414841
Name:FISCHER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:FISCHER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-270-1208
Mailing Address - Street 1:972 FISCHER BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3844
Mailing Address - Country:US
Mailing Address - Phone:732-270-1208
Mailing Address - Fax:732-270-8432
Practice Address - Street 1:972 FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3844
Practice Address - Country:US
Practice Address - Phone:732-270-1208
Practice Address - Fax:732-270-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00232100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3375102Medicaid
NJP808727OtherOXFORD INS. CO.
NJ3375102Medicaid
NJ=========OtherFED TAX ID #
NJP808727OtherOXFORD INS. CO.