Provider Demographics
NPI:1548397482
Name:FITELSON, SHARON L (DC DABCO)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:L
Last Name:FITELSON
Suffix:
Gender:F
Credentials:DC DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1325
Mailing Address - Country:US
Mailing Address - Phone:314-644-2081
Mailing Address - Fax:314-644-2309
Practice Address - Street 1:7800 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1325
Practice Address - Country:US
Practice Address - Phone:314-644-2081
Practice Address - Fax:314-644-2309
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004472111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO628178OtherUNITED HEALTHCARE PROV #
MO6332OtherBLUE CROSS PROVIDER #
MO119539OtherGHP PROVIDER #
MO287406OtherHEALTHLINK PROVIDER #
MOT43375OtherMERCY PROVIDER #
MO6332OtherBLUE CROSS PROVIDER #