Provider Demographics
NPI:1679774947
Name:FITZSIMMONS CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:FITZSIMMONS CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:FITZSIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-476-3700
Mailing Address - Street 1:300 E BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-1236
Mailing Address - Country:US
Mailing Address - Phone:815-476-3700
Mailing Address - Fax:815-476-1067
Practice Address - Street 1:300 E BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1236
Practice Address - Country:US
Practice Address - Phone:815-476-3700
Practice Address - Fax:815-476-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009926858OtherBLUE CROSS BLUE SHIELD
IL0009926858OtherBLUE CROSS BLUE SHIELD
IL598140Medicare ID - Type Unspecified