Provider Demographics
NPI:1518797596
Name:FISHER, TRAVIS (DC)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:FISHER
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 1:1471 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2272
Mailing Address - Country:US
Mailing Address - Phone:727-855-1226
Mailing Address - Fax:
Practice Address - Street 1:25749 US HIGHWAY 19 N STE 100
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2004
Practice Address - Country:US
Practice Address - Phone:727-591-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor