Provider Demographics
NPI:1255522025
Name:KITZMAN, JAY (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:KITZMAN
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 1:1101 CANAL SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LECLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-7602
Mailing Address - Country:US
Mailing Address - Phone:563-289-2166
Mailing Address - Fax:563-289-2167
Practice Address - Street 1:1101 CANAL SHORE DR.
Practice Address - Street 2:
Practice Address - City:LECLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-7602
Practice Address - Country:US
Practice Address - Phone:563-289-2166
Practice Address - Fax:563-289-2167
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007054111N00000X
IL038.011003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor