MEDICARE: FISHER FAMILY CHIROPRACTIC, S.C.

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	4590	WI

General Provider Information

NPI Number	:	1912266164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHER FAMILY CHIROPRACTIC, S.C.

Provider Business Mailing Address
First Line	:	1240 W RANCHITO LN
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-6089
Country	:	US
Telephone Number	:	262-240-9946
Fax Number	:	262-240-9947

Provider Business Practice Location Address
First Line	:	1240 W RANCHITO LN
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-6089
Country	:	US
Telephone Number	:	262-240-9946
Fax Number	:	262-240-9947

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT THEODORE FISHER JR.
Credential	:	D.C.
Telephone Number	:	906-869-6401

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	05/09/2012

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