Provider Demographics
NPI:1821378407
Name:FISHER, BRETT BEAUVAIS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:BEAUVAIS
Last Name:FISHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 SCOTTS VALLEY DR STE 100
Mailing Address - Street 2:321 LOS GATOS SARATOGA ROAD
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4547
Mailing Address - Country:US
Mailing Address - Phone:831-439-8893
Mailing Address - Fax:
Practice Address - Street 1:4113 SCOTTS VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4547
Practice Address - Country:US
Practice Address - Phone:831-439-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor