Provider Demographics
NPI:1548469265
Name:FISHER, JENNIFER ELAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELAYNE
Last Name:FISHER
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 1:114 STRAUBE CENTER BLVD
Mailing Address - Street 2:SUITE K-20-2
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1450
Mailing Address - Country:US
Mailing Address - Phone:609-915-4994
Mailing Address - Fax:
Practice Address - Street 1:114 STRAUBE CENTER BLVD
Practice Address - Street 2:SUITE K-20-2
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1450
Practice Address - Country:US
Practice Address - Phone:609-915-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00638900111N00000X
PADC009607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV08682Medicare UPIN