Provider Demographics
NPI:1639361561
Name:FIDELE, FRITZ G (DC)
Entity Type:Individual
Prefix:DR
First Name:FRITZ
Middle Name:G
Last Name:FIDELE
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 1:4301 ELYSIAN FIELDS AVE
Mailing Address - Street 2:103
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3875
Mailing Address - Country:US
Mailing Address - Phone:504-324-6416
Mailing Address - Fax:504-324-6417
Practice Address - Street 1:4301 ELYSIAN FIELDS AVE
Practice Address - Street 2:103
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3875
Practice Address - Country:US
Practice Address - Phone:504-324-6416
Practice Address - Fax:504-324-6417
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor