Provider Demographics
NPI:1881687135
Name:FRITZ, NATHAN LYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:LYLE
Last Name:FRITZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 COLLEGE DR S
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3555
Mailing Address - Country:US
Mailing Address - Phone:701-662-6555
Mailing Address - Fax:701-662-6557
Practice Address - Street 1:603 COLLEGE DR S
Practice Address - Street 2:UNIT 4
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3555
Practice Address - Country:US
Practice Address - Phone:701-662-6555
Practice Address - Fax:701-662-6557
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-10-03
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
ND661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor