Healthcare Provider Details

I. General information

NPI: 1720130743
Provider Name (Legal Business Name): MARC D FISHER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CARRIAGE LN
CHARLESTON SC
29407-6010
US

IV. Provider business mailing address

867 QUAIL DR
CHARLESTON SC
29412-4841
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-3100
  • Fax: 843-766-7798
Mailing address:
  • Phone: 843-557-9736
  • Fax: 843-766-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2728
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: