Healthcare Provider Details

I. General information

NPI: 1538930367
Provider Name (Legal Business Name): ALEC FISCO NMD, DAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 E MULBERRY ST
LEBANON OH
45036-2203
US

IV. Provider business mailing address

409 S EAST ST
LEBANON OH
45036-2313
US

V. Phone/Fax

Practice location:
  • Phone: 480-570-9124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number21-1957
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000411
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: