Healthcare Provider Details

I. General information

NPI: 1750748778
Provider Name (Legal Business Name): JESSICA FISH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 E ARAPAHOE RD #227
CENTENNIAL CO
80122-1522
US

IV. Provider business mailing address

1435 IVY ST
DENVER CO
80220-2645
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-0195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0007257
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: