Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 6241 | CO |
N | 111NN0400X | Neurology | 6241 | CO |
Y | 111NN0400X | Neurology | DC2113 | NM |
N | 111NP0017X | Pediatric Chiropractor | 6241 | CO |
N | 111NR0400X | Rehabilitation Chiropractor | 6241 | CO |
NPI | 1962739227 |
---|---|
Provider Name | Dr. Peter Fisk |
First Address | Santa Fe, NM 87505-3961 |
Second Address | Santa Fe, NM 87505-3961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2009 |
Last Update Date | 22/07/2020 |