Provider Demographics
NPI:1871880252
Name:FLUITT, KEVIN (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:FLUITT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 S LAMAR BLVD STE D-112
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8864
Mailing Address - Country:US
Mailing Address - Phone:512-441-1240
Mailing Address - Fax:512-441-3762
Practice Address - Street 1:3005 S LAMAR BLVD STE D-112
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8864
Practice Address - Country:US
Practice Address - Phone:512-441-1240
Practice Address - Fax:512-441-3762
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor