Provider Demographics
NPI:1811983836
Name:FITCH, OLIVIA A (DC)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:A
Last Name:FITCH
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 1:7105 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2009
Mailing Address - Country:US
Mailing Address - Phone:313-406-3272
Mailing Address - Fax:313-406-3332
Practice Address - Street 1:7105 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2009
Practice Address - Country:US
Practice Address - Phone:313-406-3272
Practice Address - Fax:313-406-3332
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U18935Medicare UPIN
MIMI7492Medicare PIN
U18935Medicare UPIN