Provider Demographics
NPI:1487715652
Name:FISHER, GARY MICHAEL SR (DC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:FISHER
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586
Mailing Address - Country:US
Mailing Address - Phone:812-547-7632
Mailing Address - Fax:812-547-8990
Practice Address - Street 1:807 12TH ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586
Practice Address - Country:US
Practice Address - Phone:812-547-7632
Practice Address - Fax:812-547-8990
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001114A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000042703OtherBLUE CROSS
IN000000042703OtherBLUE CROSS
839410Medicare ID - Type Unspecified