Healthcare Provider Details

I. General information

NPI: 1760509822
Provider Name (Legal Business Name): FISHER CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 CORPORATE PARK STE 204 204
IRVINE CA
92606-5137
US

IV. Provider business mailing address

43 CORPORATE PARK STE 204
IRVINE CA
92606-5137
US

V. Phone/Fax

Practice location:
  • Phone: 714-550-0788
  • Fax: 714-550-6001
Mailing address:
  • Phone: 714-550-0788
  • Fax: 714-550-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC21320
License Number StateCA

VIII. Authorized Official

Name: DR. JEFF ALLEN FISHER
Title or Position: OWNER
Credential: D.C.
Phone: 714-550-0788