MEDICARE: RICKY EVAN FISHMAN D.C.

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	DC17680	CA

General Provider Information

NPI Number	:	1851488308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKY EVAN FISHMAN D.C.

Provider Business Mailing Address
First Line	:	1626 UNION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4507
Country	:	US
Telephone Number	:	415-567-2225
Fax Number	:	415-441-9238

Provider Business Practice Location Address
First Line	:	1626 UNION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4507
Country	:	US
Telephone Number	:	415-567-2225
Fax Number	:	415-441-9238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	12/10/2021

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