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General NPI Number Information
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NPI Number | 1609896414
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Entity Type | Organization
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Legal Business Name | FISHER CHIROPRACTIC CENTER S.C.
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 9545 S 20TH ST
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City | OAK CREEK
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State | WI
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Zip | 53154-4929
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Country | US
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Telephone | 262-930-1776
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Fax | 262-364-2599
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Provider Business Mailing Address
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Address Line | 6233 DURAND AVE
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City | RACINE
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State | WI
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Zip | 53406
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Country | US
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Telephone | 262-554-6449
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Fax | 262-554-8609
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ROBERT FISHER JR.
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Credential | DC
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Telephone | 262-930-1776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3573012
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License Number State | WI
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