Provider Demographics
NPI:1447416656
Name:FITZGERALD, NANCY A (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
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 1:74-5615 LUHIA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3622
Mailing Address - Country:US
Mailing Address - Phone:808-640-8464
Mailing Address - Fax:
Practice Address - Street 1:74-5615 LUHIA ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3622
Practice Address - Country:US
Practice Address - Phone:808-640-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1047111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician