Provider Demographics
NPI:1952442410
Name:FITZGERALD CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:FITZGERALD CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-491-4118
Mailing Address - Street 1:3411 STONEY SPRING CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5433
Mailing Address - Country:US
Mailing Address - Phone:502-491-4118
Mailing Address - Fax:502-491-4019
Practice Address - Street 1:3411 STONEY SPRING CIRCLE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5433
Practice Address - Country:US
Practice Address - Phone:502-491-4118
Practice Address - Fax:502-491-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4714111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2622354000Medicaid
KYV05155Medicare UPIN