Provider Demographics
NPI:1912266164
Name:FISHER FAMILY CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:FISHER FAMILY CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:906-869-6401
Mailing Address - Street 1:1240 W RANCHITO LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-6089
Mailing Address - Country:US
Mailing Address - Phone:262-240-9946
Mailing Address - Fax:262-240-9947
Practice Address - Street 1:1240 W RANCHITO LN
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-6089
Practice Address - Country:US
Practice Address - Phone:262-240-9946
Practice Address - Fax:262-240-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty