Provider Demographics
NPI:1891888103
Name:FISHER, WILLIAM TODD (BS DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TODD
Last Name:FISHER
Suffix:
Gender:M
Credentials:BS DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 CENTREVILLE ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-378-2698
Mailing Address - Fax:703-378-1451
Practice Address - Street 1:3910 CENTREVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3279
Practice Address - Country:US
Practice Address - Phone:703-378-2698
Practice Address - Fax:703-378-1451
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
533781Medicare ID - Type Unspecified