Healthcare Provider Details

I. General information

NPI: 1669798906
Provider Name (Legal Business Name): CHERI DAWN FISHER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 OVERLAND AVE
LOS ANGELES CA
90064-3333
US

IV. Provider business mailing address

1522 EUCLID ST APT 21
SANTA MONICA CA
90404-3329
US

V. Phone/Fax

Practice location:
  • Phone: 424-261-5051
  • Fax: 310-760-2033
Mailing address:
  • Phone: 310-962-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number11733
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11733
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number11733
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number11733
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number11733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: