MEDICARE: DR. DALE A FISCHER DC

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	038-003933	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	792350300	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4405901	OTHER	IL	UNITED HEALTH CARE
2	5844505	OTHER	IL	AETNA
4	T37356	OTHER	IL	MERCY HEALTH PLANS
5	1478203622	OTHER	IL	MAIL HANDLERS
6	122910	OTHER	IL	HEALTHLINK
7	8282017	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841294436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE A FISCHER DC

Provider Business Mailing Address
First Line	:	110 W SAINT LOUIS ST
Second Line	:
City	:	LEBANON
State	:	IL
Zip	:	62254-1559
Country	:	US
Telephone Number	:	618-537-4407
Fax Number	:	618-537-4409

Provider Business Practice Location Address
First Line	:	110 W SAINT LOUIS ST
Second Line	:
City	:	LEBANON
State	:	IL
Zip	:	62254-1559
Country	:	US
Telephone Number	:	618-537-4407
Fax Number	:	618-537-4409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/15/2012

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Directions to “ DR. DALE A FISCHER DC” Practice Location

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