Provider Demographics
NPI:1831235399
Name:FITZWATER CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:FITZWATER CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FITZWATER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-475-8676
Mailing Address - Street 1:1210 E LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7128
Mailing Address - Country:US
Mailing Address - Phone:719-475-8676
Mailing Address - Fax:719-475-8678
Practice Address - Street 1:1210 E LA SALLE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7128
Practice Address - Country:US
Practice Address - Phone:719-475-8676
Practice Address - Fax:719-475-8678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO807203Medicare PIN