Provider Demographics
NPI:1023071438
Name:FISH, MARCI J (DC)
Entity type:Individual
Prefix:DR
First Name:MARCI
Middle Name:J
Last Name:FISH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IA
Mailing Address - Zip Code:50643-0177
Mailing Address - Country:US
Mailing Address - Phone:319-988-9889
Mailing Address - Fax:319-988-9292
Practice Address - Street 1:505 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IA
Practice Address - Zip Code:50643-2202
Practice Address - Country:US
Practice Address - Phone:319-988-9889
Practice Address - Fax:319-988-9292
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0475632Medicaid
39176OtherWELLMARK
247307OtherMIDLANDS CHOICE
I15837Medicare ID - Type Unspecified
IAI15836Medicare ID - Type UnspecifiedGROUP NUMBER
247307OtherMIDLANDS CHOICE