Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038-006866 | IL |
NPI | 1336361419 |
---|---|
Provider Name | Dr. Jeffery Charles Fishel |
First Address | Arcola, IL 61910-1303 |
Second Address | Arcola, IL 61910-1303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 12/03/2012 |