Provider Demographics
NPI:1982744629
Name:FISSINGER, EDWIN MONETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:MONETTE
Last Name:FISSINGER
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 1:6550 YORK AVE S
Mailing Address - Street 2:SUITE 515
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2347
Mailing Address - Country:US
Mailing Address - Phone:952-926-7515
Mailing Address - Fax:952-926-8155
Practice Address - Street 1:6550 YORK AVE S
Practice Address - Street 2:SUITE 515
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2347
Practice Address - Country:US
Practice Address - Phone:952-926-7515
Practice Address - Fax:952-926-8155
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN123OtherCHIRO SERV
MN3D482FIOtherBLUE CROSS BLUE SHIELD
MN841828400OtherMINNESOTA CARE
MN3D482FIOtherBLUE CROSS BLUE SHIELD