Active NPI
Brad Michael Fisher, DC
- Chiropractor
- Manito, IL
National Provider Identifier
1760554133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038009721
- Practice address
- 408 S Adams
Manito, IL 61546 - Phone
- (309) 968-7054
- Fax
- (309) 968-7054
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038009721 | IL | Primary |
Addresses
Primary practice location
408 S Adams
Manito, IL 61546
Mailing address
408 S Adams
Manito, IL 61546
Phone (309) 968-7054
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 038009721 | Medicaid | IL | |
| 09032018 | Other | BCBS IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041021000777 | IL | Practitioner - Chiropractic | 7719948876 | Practice locations: Manito, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
408 S Adams St
Manito, IL 61546-9302
Phone (309) 968-7054
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210118400000",
"number": "1760554133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 S ADAMS",
"city": "MANITO",
"state": "IL",
"postal_code": "61546",
"telephone_number": "309-968-7054",
"fax_number": "309-968-7054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 S ADAMS",
"city": "MANITO",
"state": "IL",
"postal_code": "61546",
"telephone_number": "309-968-7054",
"fax_number": "309-968-7054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHER",
"first_name": "BRAD",
"middle_name": "MICHAEL",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2008-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038009721",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "038009721",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS IL",
"identifier": "09032018",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Manito, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.