Provider Demographics
NPI:1447673306
Name:FISHER, LINDSEY MARIE (DC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:MARIE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1904 W GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4406
Mailing Address - Country:US
Mailing Address - Phone:903-561-0086
Mailing Address - Fax:903-561-2576
Practice Address - Street 1:1904 W GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4406
Practice Address - Country:US
Practice Address - Phone:903-561-0086
Practice Address - Fax:903-561-2576
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor