Provider Demographics
NPI:1790222644
Name:FISCHER, KEVIN (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:FISCHER
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 1:3331 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4554
Mailing Address - Country:US
Mailing Address - Phone:732-455-5617
Mailing Address - Fax:732-455-5618
Practice Address - Street 1:3331 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4554
Practice Address - Country:US
Practice Address - Phone:732-455-5617
Practice Address - Fax:732-455-5618
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor