Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 3155 | MN |
N | 111NR0400X | Rehabilitation Chiropractor | DACRB | MN |
NPI | 1417032061 |
---|---|
Provider Name | Dr. David W Fisher |
First Address | Duluth, MN 55802-2217 |
Second Address | Duluth, MN 55802-2217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3C750FI | BCBS (01) | MN |
U48175 | (02) |