Provider Demographics
NPI:1649210972
Name:FITZWATER, GLENN S (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:S
Last Name:FITZWATER
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 1:113 HOKE STREET
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1744
Mailing Address - Country:US
Mailing Address - Phone:256-546-3047
Mailing Address - Fax:256-546-7116
Practice Address - Street 1:113 HOKE STREET
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1744
Practice Address - Country:US
Practice Address - Phone:256-546-3047
Practice Address - Fax:256-546-7116
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1359111N00000X
OH1671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA350019263OtherRAILROAD MEDICARE
GA350019263OtherRAILROAD MEDICARE
U16513Medicare UPIN