Provider Demographics
NPI:1841294436
Name:FISCHER, DALE A (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:A
Last Name:FISCHER
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 1:110 W SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254-1559
Mailing Address - Country:US
Mailing Address - Phone:618-537-4407
Mailing Address - Fax:618-537-4409
Practice Address - Street 1:110 W SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IL
Practice Address - Zip Code:62254-1559
Practice Address - Country:US
Practice Address - Phone:618-537-4407
Practice Address - Fax:618-537-4409
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4405901OtherUNITED HEALTH CARE
IL5844505OtherAETNA
IL792350300OtherRAILROAD MEDICARE
ILT37356OtherMERCY HEALTH PLANS
IL1478203622OtherMAIL HANDLERS
IL122910OtherHEALTHLINK
IL8282017OtherBLUE CROSS BLUE SHIELD
IL8282017OtherBLUE CROSS BLUE SHIELD
T37356Medicare UPIN