Provider Demographics
NPI:1093869646
Name:FITZMAURICE, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:FITZMAURICE
Suffix:
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 1:310 N WILMOT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2618
Mailing Address - Country:US
Mailing Address - Phone:520-296-2515
Mailing Address - Fax:520-731-6597
Practice Address - Street 1:310 N WILMOT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2618
Practice Address - Country:US
Practice Address - Phone:520-296-2515
Practice Address - Fax:520-731-6597
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7023111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0934970OtherBLUE CROSS BLUE SHIELD
AZT43284Medicare UPIN
AZZ67786Medicare ID - Type Unspecified