Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 11733 | CA |
N | 111NN1001X | Nutrition | 11733 | CA |
Y | 111NR0400X | Rehabilitation Chiropractor | 11733 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 11733 | CA |
N | 111NX0100X | Occupational Health | 11733 | CA |
NPI | 1669798906 |
---|---|
Provider Name | Dr. Cheri Dawn Fisher |
First Address | Santa Monica, CA 90404-3329 |
Second Address | Los Angeles, CA 90064-3333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 13/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
166979806 | NPPES (01) | CA |