Provider Demographics
NPI:1326293804
Name:FITCH, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:FITCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 SW LOOP 410
Mailing Address - Street 2:#227
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227
Mailing Address - Country:US
Mailing Address - Phone:210-927-0000
Mailing Address - Fax:210-670-9948
Practice Address - Street 1:1305 SW LOOP 410
Practice Address - Street 2:#227
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227
Practice Address - Country:US
Practice Address - Phone:210-927-0000
Practice Address - Fax:210-670-9948
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10143111N00000X
NM1585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor