Provider Demographics
NPI:1962739227
Name:FISK, PETER (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:FISK
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 1:826 CAMINO DE MONTE REY STE A7
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3961
Mailing Address - Country:US
Mailing Address - Phone:505-954-1024
Mailing Address - Fax:505-365-2791
Practice Address - Street 1:826 CAMINO DE MONTE REY STE A7
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3961
Practice Address - Country:US
Practice Address - Phone:505-954-1024
Practice Address - Fax:505-365-2791
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6241111N00000X, 111NN0400X, 111NP0017X, 111NR0400X
NMDC2113111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitation