Provider Demographics
NPI:1871793026
Name:FISHER, PAUL W (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:FISHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:39284 PASEO PADRE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1616
Mailing Address - Country:US
Mailing Address - Phone:510-797-4796
Mailing Address - Fax:510-573-6316
Practice Address - Street 1:39284 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1616
Practice Address - Country:US
Practice Address - Phone:510-797-4796
Practice Address - Fax:510-573-6316
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC016176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0161760Medicare PIN