Provider Demographics
NPI:1144233701
Name:FITZPATRICK, MARC A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:FITZPATRICK
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 1:250 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2244
Mailing Address - Country:US
Mailing Address - Phone:979-968-3340
Mailing Address - Fax:979-968-6630
Practice Address - Street 1:250 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2244
Practice Address - Country:US
Practice Address - Phone:979-968-3340
Practice Address - Fax:979-968-6630
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8178983OtherBLUE LINK NUMBER
TXP085V0302Medicaid
TXP085V0302Medicaid
TXT78983Medicare UPIN