Provider Demographics
NPI:1679776009
Name:FITZWILLIAMS, LISA ANN (DC, CN)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:FITZWILLIAMS
Suffix:
Gender:F
Credentials:DC, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 HIGHWAY 133
Mailing Address - Street 2:SUITE 270A
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-2507
Mailing Address - Country:US
Mailing Address - Phone:970-987-4470
Mailing Address - Fax:970-797-1493
Practice Address - Street 1:326 HIGHWAY 133
Practice Address - Street 2:SUITE 270A
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2507
Practice Address - Country:US
Practice Address - Phone:970-987-4470
Practice Address - Fax:970-797-1493
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006444111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition