MEDICARE: FISHER FAMILY CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	16761	CA

General Provider Information

NPI Number	:	1669740148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHER FAMILY CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	112 EL VISTA AVE
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95354-3006
Country	:	US
Telephone Number	:	209-526-1284
Fax Number	:	209-526-3781

Provider Business Practice Location Address
First Line	:	112 EL VISTA AVE
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95354-3006
Country	:	US
Telephone Number	:	209-526-1284
Fax Number	:	209-526-3781

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	PAUL W. FISHER
Credential	:	D.C.
Telephone Number	:	209-526-1284

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	12/28/2011

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