Provider Demographics
NPI:1942208871
Name:FISHER, DALE P (DC)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:P
Last Name:FISHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:DALE
Other - Middle Name:PERRY
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:18055 BUSHARD ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5760
Mailing Address - Country:US
Mailing Address - Phone:714-964-4444
Mailing Address - Fax:714-963-5644
Practice Address - Street 1:18055 BUSHARD ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5760
Practice Address - Country:US
Practice Address - Phone:714-964-4444
Practice Address - Fax:714-963-5644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T17520Medicare UPIN