Provider Demographics
NPI:1457303612
Name:FITZENRIDER, ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:FITZENRIDER
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 1:3033 WILSON BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3868
Mailing Address - Country:US
Mailing Address - Phone:703-963-4257
Mailing Address - Fax:
Practice Address - Street 1:3033 WILSON BLVD STE 700
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3868
Practice Address - Country:US
Practice Address - Phone:703-963-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104555721111N00000X
VA0104555721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35001263Medicare PIN