Provider Demographics
NPI:1982852869
Name:FITZPATRICK, MICHAEL DENNIS (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DENNIS
Last Name:FITZPATRICK
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 1:1225 FARR
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-8582
Mailing Address - Country:US
Mailing Address - Phone:936-931-5100
Mailing Address - Fax:936-372-5005
Practice Address - Street 1:1225 FARR ST
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8486
Practice Address - Country:US
Practice Address - Phone:936-931-5100
Practice Address - Fax:936-372-5005
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088417302Medicaid
TX088417302Medicaid
TX85V031Medicare PIN