Healthcare Provider Details

I. General information

NPI: 1841294436
Provider Name (Legal Business Name): DALE A FISCHER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W SAINT LOUIS ST
LEBANON IL
62254-1559
US

IV. Provider business mailing address

110 W SAINT LOUIS ST
LEBANON IL
62254-1559
US

V. Phone/Fax

Practice location:
  • Phone: 618-537-4407
  • Fax: 618-537-4409
Mailing address:
  • Phone: 618-537-4407
  • Fax: 618-537-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-003933
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: