Provider Demographics
NPI:1851914345
Name:FITZGERALD, KENNEDY CLAIRE (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:CLAIRE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KENNEDY
Other - Middle Name:CLAIRE
Other - Last Name:CULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:448 LEONARD ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4250
Mailing Address - Country:US
Mailing Address - Phone:616-805-4478
Mailing Address - Fax:616-805-4865
Practice Address - Street 1:448 LEONARD ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4250
Practice Address - Country:US
Practice Address - Phone:616-805-4478
Practice Address - Fax:616-805-4865
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor