NPIMap

Organization Active NPI

Fisher Chiropractic Clinic LTD

  • Chiropractor
  • Duluth, MN
National Provider Identifier
1265517809
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
717 Issued in MN
Legal business name
FISHER CHIROPRACTIC CLINIC LTD
Practice address
1118 E Superior St
Duluth, MN 55802-2217
Phone
(218) 728-3639
Fax
(218) 728-2603
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David W Fisher, DC CCST DACRBNPI 1417032061
Title
DC Owner
Phone
(218) 728-3639

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 717 MN Primary

Addresses

Primary practice location

1118 E Superior St
Duluth, MN 55802-2217

Mailing address

1118 E Superior St
Duluth, MN 55802-2217
Phone (218) 728-3639

Other identifiers 1

IdentifierTypeStateIssuer
75004FIOtherMNBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080318000400 MN Part B Supplier - Clinic/Group Practice 4981780897 Receives reassigned benefits from 3 practitioners
Practice locations: Duluth, MN

National Provider Directory

National Provider Directory

Locations

1118 E Superior St
Duluth, MN 55802
Phone (218) 724-4077

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265517809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 E SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022217",
            "telephone_number": "218-728-3639",
            "fax_number": "218-728-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 E SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022217",
            "telephone_number": "218-728-3639",
            "fax_number": "218-728-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FISHER CHIROPRACTIC CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DC OWNER",
        "authorized_official_telephone_number": "218-728-3639",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC CCST DACRB"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "75004FI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.