Provider Demographics
NPI:1942724836
Name:FIDLER, JAMIE LEE (DC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:FIDLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E MAUMEE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1978
Mailing Address - Country:US
Mailing Address - Phone:260-667-8269
Mailing Address - Fax:
Practice Address - Street 1:114 E MAUMEE ST STE 101
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1978
Practice Address - Country:US
Practice Address - Phone:260-667-8269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002990A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor