Provider Demographics
NPI:1013928100
Name:FITZGERALD, DARYL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:THOMAS
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 1:9 MOTT AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3330
Mailing Address - Country:US
Mailing Address - Phone:203-853-6130
Mailing Address - Fax:203-838-5801
Practice Address - Street 1:9 MOTT AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3330
Practice Address - Country:US
Practice Address - Phone:203-853-6130
Practice Address - Fax:203-838-5801
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001135111N00000X
NYX007801-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001135CT01OtherBLUECROSS BLUESHIELD ID #
CTZS817OtherOXFORD HEALTH PLANS ID #