Provider Demographics
NPI:1902044498
Name:SP CHIROPRACTIC ENTERPRISES LLC
Entity Type:Organization
Organization Name:SP CHIROPRACTIC ENTERPRISES LLC
Other - Org Name:FISHER CHIROPRACTIC AND INTEGRATIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-455-4545
Mailing Address - Street 1:930 N YORK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3595
Mailing Address - Country:US
Mailing Address - Phone:630-455-4545
Mailing Address - Fax:
Practice Address - Street 1:930 N YORK RD STE 100
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3595
Practice Address - Country:US
Practice Address - Phone:630-455-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011350111N00000X
IL038011321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty