Provider Demographics
NPI:1417986845
Name:FITZPATRICK, CHARLES DAREN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAREN
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 1:2130 MCGREGOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3418
Mailing Address - Country:US
Mailing Address - Phone:239-333-2233
Mailing Address - Fax:239-333-2234
Practice Address - Street 1:2130 MCGREGOR BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3418
Practice Address - Country:US
Practice Address - Phone:239-333-2233
Practice Address - Fax:239-333-2234
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55877AMedicare PIN
FLU96542Medicare UPIN