Healthcare Provider Details

I. General information

NPI: 1104044593
Provider Name (Legal Business Name): PETER NORMAN FYSH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W FREMONT AVE SUITE M
SUNNYVALE CA
94087-3021
US

IV. Provider business mailing address

5823 KILLARNEY CIR
SAN JOSE CA
95138-2345
US

V. Phone/Fax

Practice location:
  • Phone: 408-773-9165
  • Fax: 408-773-8556
Mailing address:
  • Phone: 408-773-9165
  • Fax: 408-773-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number19790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: