Provider Demographics
NPI:1780023903
Name:FISHER OF MEN, LLC
Entity Type:Organization
Organization Name:FISHER OF MEN, LLC
Other - Org Name:RENATO HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:RENATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-706-2378
Mailing Address - Street 1:18 OAK FOREST RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4989
Mailing Address - Country:US
Mailing Address - Phone:843-706-2378
Mailing Address - Fax:843-706-2178
Practice Address - Street 1:18 OAK FOREST RD
Practice Address - Street 2:SUITE C
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4989
Practice Address - Country:US
Practice Address - Phone:843-706-2378
Practice Address - Fax:843-706-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCH1445111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT446920281Medicare PIN