Provider Demographics
NPI:1952638926
Name:FITZGERALD, GEORGE H (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:FITZGERALD
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 1:856 W EL CAMINO REAL
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2593
Mailing Address - Country:US
Mailing Address - Phone:650-967-2512
Mailing Address - Fax:650-967-2683
Practice Address - Street 1:856 W EL CAMINO REAL
Practice Address - Street 2:SUITE D
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2593
Practice Address - Country:US
Practice Address - Phone:650-967-2512
Practice Address - Fax:650-967-2683
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor