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General NPI Number Information
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NPI Number | 1891888103
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Entity Type | Individual
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Provider Name | WILLIAM TODD FISHER BS DC
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 3910 CENTREVILLE RD SUITE 202
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City | CHANTILLY
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State | VA
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Zip | 20151-3279
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Country | US
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Telephone | 703-378-2698
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Fax | 703-378-1451
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Provider Business Mailing Address
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Address Line | 3910 CENTREVILLE ROAD SUITE 202
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City | CHANTILLY
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State | VA
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Zip | 20151
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Country | US
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Telephone | 703-378-2698
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Fax | 703-378-1451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0104000705
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License Number State | VA
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