Provider Demographics
NPI:1780201970
Name:FISHER, WILSON-JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:WILSON-JACOB
Middle Name:
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 1:8600 E ROCKCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-9729
Mailing Address - Country:US
Mailing Address - Phone:906-250-6801
Mailing Address - Fax:
Practice Address - Street 1:1313 S CLARKSON ST STE 1
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2284
Practice Address - Country:US
Practice Address - Phone:303-744-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9092111N00000X
COCHR.0008222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor