Provider Demographics
NPI:1407147937
Name:FITZGERALD, JAMI LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMI
Middle Name:LYNN
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CINNABAR CT
Mailing Address - Street 2:
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515-1151
Mailing Address - Country:US
Mailing Address - Phone:707-942-4388
Mailing Address - Fax:707-942-4388
Practice Address - Street 1:1900 CINNABAR CT
Practice Address - Street 2:
Practice Address - City:CALISTOGA
Practice Address - State:CA
Practice Address - Zip Code:94515-1151
Practice Address - Country:US
Practice Address - Phone:707-942-4388
Practice Address - Fax:707-942-4388
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0207000Medicare PIN
CAU-13336Medicare UPIN