1760509822 NPI number — FISHER CHIROPRACTIC, INC.

Table of content: (NPI 1760509822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760509822 NPI number — FISHER CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FISHER CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760509822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 CORPORATE PARK STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92606-5137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-550-0788
Provider Business Mailing Address Fax Number:
714-550-6001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 CORPORATE PARK STE 204
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92606-5137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-550-0788
Provider Business Practice Location Address Fax Number:
714-550-6001
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-550-0788

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  DC21320 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT15475 . This is a "PHYSICAL THERAPY LIC." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC21320 . This is a "CHIROPRACTIC CORP." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: OT5117CA . This is a "OCCUPATIONAL THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528089182 . This is a "PT-28250" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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