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General NPI Number Information
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NPI Number | 1912266164
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Entity Type | Organization
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Legal Business Name | FISHER FAMILY CHIROPRACTIC, S.C.
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 1240 W RANCHITO LN
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City | MEQUON
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State | WI
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Zip | 53092-6089
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Country | US
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Telephone | 262-240-9946
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Fax | 262-240-9947
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Provider Business Mailing Address
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Address Line | 1240 W RANCHITO LN
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City | MEQUON
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State | WI
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Zip | 53092-6089
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Country | US
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Telephone | 262-240-9946
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Fax | 262-240-9947
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT THEODORE FISHER JR.
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Credential | D.C.
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Telephone | 906-869-6401
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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 | 4590
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License Number State | WI
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