=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285617514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR PAUL S FISHER PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2005
-----------------------------------------------------
Last Update Date | 11/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13710 SW 84 ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-385-7200
-----------------------------------------------------
Fax | 305-380-7532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13710 SW 84 ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-385-7200
-----------------------------------------------------
Fax | 305-380-7532
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. PAUL S FISHER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 305-385-7200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH0002703
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------