Provider Demographics
NPI:1477525814
Name:FRITZ, BRIAN S (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:FRITZ
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 1:2501 S CENTER ST
Mailing Address - Street 2:STE E
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4545
Mailing Address - Country:US
Mailing Address - Phone:641-752-3112
Mailing Address - Fax:641-752-8822
Practice Address - Street 1:2501 S CENTER ST
Practice Address - Street 2:STE E
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4545
Practice Address - Country:US
Practice Address - Phone:641-752-3112
Practice Address - Fax:641-752-8822
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1149930Medicaid
IA350050080ROtherRR MEDICARE
IA622952OtherUNITED HEALTH
45800OtherBCBS
IA1149930Medicaid
IA622952OtherUNITED HEALTH