Provider Demographics
NPI:1851488308
Name:FISHMAN, RICKY EVAN (DC)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:EVAN
Last Name:FISHMAN
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 1:1626 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4507
Mailing Address - Country:US
Mailing Address - Phone:415-567-2225
Mailing Address - Fax:415-441-9238
Practice Address - Street 1:1626 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4507
Practice Address - Country:US
Practice Address - Phone:415-567-2225
Practice Address - Fax:415-441-9238
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0176800Medicare ID - Type Unspecified