Healthcare Provider Details

I. General information

NPI: 1376721118
Provider Name (Legal Business Name): MICHELLE ANN FISHER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE ANN FISHER-ROTHERY DC

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date: 09/25/2019
Reactivation Date: 03/30/2023

III. Provider practice location address

4079 TONGASS AVE SUITE 102
KETCHIKAN AK
99901
US

IV. Provider business mailing address

4079 TONGASS AVE SUITE 102
KETCHIKAN AK
99901
US

V. Phone/Fax

Practice location:
  • Phone: 907-225-7808
  • Fax: 907-247-7868
Mailing address:
  • Phone: 907-225-7808
  • Fax: 907-247-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1292
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: