Provider Demographics
NPI:1609847128
Name:FRITZ CHIROPRACTIC DC PC
Entity type:Organization
Organization Name:FRITZ CHIROPRACTIC DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-752-3112
Mailing Address - Street 1:2501 S CENTER ST
Mailing Address - Street 2:STE E
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4545
Mailing Address - Country:US
Mailing Address - Phone:641-752-3112
Mailing Address - Fax:641-752-8822
Practice Address - Street 1:2501 S CENTER ST
Practice Address - Street 2:STE E
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4545
Practice Address - Country:US
Practice Address - Phone:641-752-3112
Practice Address - Fax:641-752-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0292417Medicaid
I7213Medicare ID - Type Unspecified