Provider Demographics
NPI:1407936586
Name:FITZPATRICK, VINCE L (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCE
Middle Name:L
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:VINCE
Other - Middle Name:L
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:18211 E APPLEWAY
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016
Mailing Address - Country:US
Mailing Address - Phone:509-926-1551
Mailing Address - Fax:509-926-1661
Practice Address - Street 1:18211 E APPLEWAY
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:WA
Practice Address - Zip Code:99016
Practice Address - Country:US
Practice Address - Phone:509-926-1551
Practice Address - Fax:509-926-1661
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2315505Medicaid
WA350016953OtherRR MEDICARE
WA14817OtherL I
WAE11435OtherASURIS
WA14817OtherL I
WA000300503Medicare PIN
WAG000300503Medicare PIN