Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | B01260 | NV |
N | 111NI0013X | Independent Medical Examiner | B01260 | NV |
NPI | 1922208321 |
---|---|
Provider Name | Dr. Jacob Wayne Fisk |
First Address | Las Vegas, NV 89145-0307 |
Second Address | Las Vegas, NV 89145-0307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 27/05/2021 |