Provider Demographics
NPI:1881628303
Name:FITZGERALD, CASEY A (DC)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:A
Last Name:FITZGERALD
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 1:5421 MATLOCK RD
Mailing Address - Street 2:#125
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1532
Mailing Address - Country:US
Mailing Address - Phone:817-466-9400
Mailing Address - Fax:817-466-9787
Practice Address - Street 1:5421 MATLOCK RD
Practice Address - Street 2:#125
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1532
Practice Address - Country:US
Practice Address - Phone:817-466-9400
Practice Address - Fax:817-466-9787
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0885Medicare PIN