Provider Demographics
NPI:1760787139
Name:FRITZ, JUSTIN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ANTHONY
Last Name:FRITZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1625 RADIO DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9407
Mailing Address - Country:US
Mailing Address - Phone:651-731-5124
Mailing Address - Fax:651-731-0509
Practice Address - Street 1:1625 RADIO DR
Practice Address - Street 2:SUITE 160
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9407
Practice Address - Country:US
Practice Address - Phone:651-731-5124
Practice Address - Fax:651-731-0509
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN5453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor