Provider Demographics
NPI:1558614719
Name:JAMES E. FITZPATRICK, D.C. PS
Entity Type:Organization
Organization Name:JAMES E. FITZPATRICK, D.C. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-392-5321
Mailing Address - Street 1:465 RAINIER BLVD N
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2826
Mailing Address - Country:US
Mailing Address - Phone:425-392-5321
Mailing Address - Fax:425-837-3785
Practice Address - Street 1:465 RAINIER BLVD N
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2826
Practice Address - Country:US
Practice Address - Phone:425-392-5321
Practice Address - Fax:425-837-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH000000801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61981OtherMEDICARE TIN
WA61981OtherMEDICARE TIN