Provider Demographics
NPI:1639423056
Name:BRANDON FITCH, P.A.
Entity Type:Organization
Organization Name:BRANDON FITCH, P.A.
Other - Org Name:FITCH FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-715-8033
Mailing Address - Street 1:211 NE A ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5315
Mailing Address - Country:US
Mailing Address - Phone:479-273-9715
Mailing Address - Fax:
Practice Address - Street 1:211 NE A ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5315
Practice Address - Country:US
Practice Address - Phone:479-273-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty