Healthcare Provider Details

I. General information

NPI: 1194235127
Provider Name (Legal Business Name): NATHAN R. FISHER, D.C., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 QUADRANGLE DR STE F
BOLINGBROOK IL
60440-3455
US

IV. Provider business mailing address

440 QUADRANGLE DR STE F
BOLINGBROOK IL
60440-3455
US

V. Phone/Fax

Practice location:
  • Phone: 630-771-1212
  • Fax: 630-759-0260
Mailing address:
  • Phone: 630-771-1212
  • Fax: 630-759-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011860
License Number StateIL

VIII. Authorized Official

Name: DR. NATHAN R FISHER
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 630-301-2035