Provider Demographics
NPI:1265517809
Name:FISHER CHIROPRACTIC CLINIC LTD
Entity type:Organization
Organization Name:FISHER CHIROPRACTIC CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCST DACRB
Authorized Official - Phone:218-728-3639
Mailing Address - Street 1:1118 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2217
Mailing Address - Country:US
Mailing Address - Phone:218-728-3639
Mailing Address - Fax:218-728-2603
Practice Address - Street 1:1118 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2217
Practice Address - Country:US
Practice Address - Phone:218-728-3639
Practice Address - Fax:218-728-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN75004FIOtherBCBS
MNC08192Medicare ID - Type Unspecified