MEDICARE: DR. NELSON FISHER GREGORY 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	0104000707	VA
2	111NS0005X	Sports Physician Chiropractor	0104000707	VA
3	111NR0400X	Rehabilitation Chiropractor	0104000707	VA

General Provider Information

NPI Number	:	1972502250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON FISHER GREGORY D.C.

Provider Business Mailing Address
First Line	:	2901 STONEWALL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3554
Country	:	US
Telephone Number	:	804-814-3545
Fax Number	:	804-977-1301

Provider Business Practice Location Address
First Line	:	5317 A LAKESIDE AVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228
Country	:	US
Telephone Number	:	804-303-4961
Fax Number	:	804-912-2366

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/27/2020

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