Provider Demographics
NPI:1104291525
Name:FIFE, DAVID J (LAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:FIFE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:W307N1497 GOLF RD
Mailing Address - Street 2:#104
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2112
Mailing Address - Country:US
Mailing Address - Phone:262-337-9578
Mailing Address - Fax:
Practice Address - Street 1:W307N1497 GOLF RD
Practice Address - Street 2:#104
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2112
Practice Address - Country:US
Practice Address - Phone:262-337-9578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI648171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist