Provider Demographics
NPI:1265899041
Name:FISHER, OLIVIA M (DC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:FISHER
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 1:11209 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4367
Mailing Address - Country:US
Mailing Address - Phone:870-247-1008
Mailing Address - Fax:
Practice Address - Street 1:7721 DOLLARWAY RD STE 1
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3040
Practice Address - Country:US
Practice Address - Phone:870-247-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11209OtherADDRESS
AR06100OtherLICENSE NUMBER