Provider Demographics
NPI:1750311940
Name:FETZER FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:FETZER FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FETZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-356-6700
Mailing Address - Street 1:4553 9TH AVE S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7253
Mailing Address - Country:US
Mailing Address - Phone:701-356-6700
Mailing Address - Fax:
Practice Address - Street 1:4553 9TH AVE S
Practice Address - Street 2:SUITE 4
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7253
Practice Address - Country:US
Practice Address - Phone:701-356-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty