Provider Demographics
NPI:1871778472
Name:FISHER, JOHN LUTHER (DC, RAS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LUTHER
Last Name:FISHER
Suffix:
Gender:M
Credentials:DC, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11161 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2336
Mailing Address - Country:US
Mailing Address - Phone:310-677-7997
Mailing Address - Fax:
Practice Address - Street 1:11161 CRENSHAW BLVD STE 150
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2354
Practice Address - Country:US
Practice Address - Phone:310-677-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF0502181639101YA0400X
CADC10338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)