Provider Demographics
NPI:1487193231
Name:FRITZ WELLNESS, PROFESSIONAL COMPANY
Entity Type:Organization
Organization Name:FRITZ WELLNESS, PROFESSIONAL COMPANY
Other - Org Name:FRITZ WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-772-3982
Mailing Address - Street 1:1749 TERRY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2047
Mailing Address - Country:US
Mailing Address - Phone:303-772-3982
Mailing Address - Fax:303-772-0990
Practice Address - Street 1:1749 TERRY ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2047
Practice Address - Country:US
Practice Address - Phone:303-772-3982
Practice Address - Fax:303-772-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty