Provider Demographics
NPI:1184691719
Name:WEIR-FISHER, RENEE ANN (DC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN
Last Name:WEIR-FISHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ANN
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:702 S GILBERT ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-1738
Mailing Address - Country:US
Mailing Address - Phone:319-248-1111
Mailing Address - Fax:319-248-1111
Practice Address - Street 1:702 S GILBERT ST
Practice Address - Street 2:SUITE 108
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-1738
Practice Address - Country:US
Practice Address - Phone:319-248-1111
Practice Address - Fax:319-248-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24277OtherBLUE CROSS PROVIDER
IA24277OtherBLUE CROSS PROVIDER
IAU97848Medicare UPIN