Provider Demographics
NPI:1427038702
Name:FITTERER, DENNIS JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JAMES
Last Name:FITTERER
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 1:112 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-2435
Mailing Address - Country:US
Mailing Address - Phone:717-838-2071
Mailing Address - Fax:717-838-6116
Practice Address - Street 1:112 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-2435
Practice Address - Country:US
Practice Address - Phone:717-838-2071
Practice Address - Fax:717-838-6116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC1833-0111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003515OtherPA BLUE SHIELD
PA003515Medicare ID - Type Unspecified
PA003515OtherPA BLUE SHIELD