Provider Demographics
NPI:1639468879
Name:MICHAEL D. FITZPATRICK D.C. PC
Entity Type:Organization
Organization Name:MICHAEL D. FITZPATRICK D.C. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-966-8264
Mailing Address - Street 1:1525 CYPRESS CREEK RD
Mailing Address - Street 2:STE. D
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3603
Mailing Address - Country:US
Mailing Address - Phone:512-249-6848
Mailing Address - Fax:512-249-9209
Practice Address - Street 1:1525 CYPRESS CREEK RD
Practice Address - Street 2:STE. D
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3603
Practice Address - Country:US
Practice Address - Phone:512-249-6848
Practice Address - Fax:512-249-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85V031Medicare PIN
TXU19825Medicare UPIN