Provider Demographics
NPI:1093990244
Name:DR ELLEN FITZENRIDER PLLC
Entity Type:Organization
Organization Name:DR ELLEN FITZENRIDER PLLC
Other - Org Name:COLLEY AVENUE CHIROPRACTIC AND BODYWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FITZENRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-627-6357
Mailing Address - Street 1:1906 COLLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1613
Mailing Address - Country:US
Mailing Address - Phone:757-627-3657
Mailing Address - Fax:757-627-2061
Practice Address - Street 1:1906 COLLEY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1613
Practice Address - Country:US
Practice Address - Phone:757-627-3657
Practice Address - Fax:757-627-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08348Medicare PIN