Provider Demographics
NPI:1851936827
Name:FISK, BRIAN ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROSS
Last Name:FISK
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 1:1119 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3732
Mailing Address - Country:US
Mailing Address - Phone:402-984-3528
Mailing Address - Fax:
Practice Address - Street 1:422 N HASTINGS AVE # 201
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5169
Practice Address - Country:US
Practice Address - Phone:402-984-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor