Provider Demographics
NPI:1063685857
Name:VINCE L. FITZPATRICK DC
Entity Type:Organization
Organization Name:VINCE L. FITZPATRICK DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-926-1551
Mailing Address - Street 1:18211 E APPLEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9564
Mailing Address - Country:US
Mailing Address - Phone:509-926-1551
Mailing Address - Fax:509-926-1661
Practice Address - Street 1:18211 E APPLEWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-9564
Practice Address - Country:US
Practice Address - Phone:509-926-1551
Practice Address - Fax:509-926-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA14817OtherL AND I
WA111N00000XOtherTAXONOMY
WAC46634OtherRAILROAD MEDICARE
WA2315505Medicaid
WAC46634OtherRAILROAD MEDICARE
WAT02294Medicare UPIN
WA2315505Medicaid