MEDICARE: FISHER CHIROPRACTIC CLINIC LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	717	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75004FI	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1265517809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHER CHIROPRACTIC CLINIC LTD

Provider Business Mailing Address
First Line	:	1118 E SUPERIOR ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2217
Country	:	US
Telephone Number	:	218-728-3639
Fax Number	:	218-728-2603

Provider Business Practice Location Address
First Line	:	1118 E SUPERIOR ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2217
Country	:	US
Telephone Number	:	218-728-3639
Fax Number	:	218-728-2603

Authorized Official
Title or Position	:	DC OWNER
Name	:	DR. DAVID W FISHER
Credential	:	DC CCST DACRB
Telephone Number	:	218-728-3639

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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