Provider Demographics
NPI:1336361419
Name:FISHEL, JEFFERY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:CHARLES
Last Name:FISHEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W MAIN ST
Mailing Address - Street 2:P.O. BOX 31
Mailing Address - City:ARCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61910-1303
Mailing Address - Country:US
Mailing Address - Phone:217-840-3642
Mailing Address - Fax:
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCOLA
Practice Address - State:IL
Practice Address - Zip Code:61910-1303
Practice Address - Country:US
Practice Address - Phone:217-840-3642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006866111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation