Healthcare Provider Details

I. General information

NPI: 1265517809
Provider Name (Legal Business Name): FISHER CHIROPRACTIC CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 E SUPERIOR ST
DULUTH MN
55802-2217
US

IV. Provider business mailing address

1118 E SUPERIOR ST
DULUTH MN
55802-2217
US

V. Phone/Fax

Practice location:
  • Phone: 218-728-3639
  • Fax: 218-728-2603
Mailing address:
  • Phone: 218-728-3639
  • Fax: 218-728-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number717
License Number StateMN

VIII. Authorized Official

Name: DR. DAVID W FISHER
Title or Position: DC OWNER
Credential: DC CCST DACRB
Phone: 218-728-3639