Provider Demographics
NPI:1336213149
Name:FRITSCH, SHANNA C (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:C
Last Name:FRITSCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 W CORTLAND ST
Mailing Address - Street 2:2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4370
Mailing Address - Country:US
Mailing Address - Phone:815-793-2951
Mailing Address - Fax:
Practice Address - Street 1:65 E WACKER PL
Practice Address - Street 2:SUITE 1615
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7296
Practice Address - Country:US
Practice Address - Phone:815-793-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor