Provider Demographics
NPI:1457424152
Name:MOORE-FISHER, JULIE (DC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MOORE-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 1:1132 BURRELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-7101
Mailing Address - Country:US
Mailing Address - Phone:208-743-0231
Mailing Address - Fax:208-746-7462
Practice Address - Street 1:1132 BURRELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7101
Practice Address - Country:US
Practice Address - Phone:208-743-0231
Practice Address - Fax:208-746-7462
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1675410Medicare ID - Type Unspecified
IDU98590Medicare UPIN