Provider Demographics
NPI:1881018653
Name:FITZPATRICK, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6303
Mailing Address - Country:US
Mailing Address - Phone:406-539-8136
Mailing Address - Fax:
Practice Address - Street 1:4501 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5919
Practice Address - Country:US
Practice Address - Phone:907-729-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-LIC-1053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor