Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 0104556329 | VA |
Y | 111NR0400X | Rehabilitation Chiropractor | 0104556329 | VA |
N | 111NS0005X | Chiropractic Sports Physician | 0104556329 | VA |
NPI | 1083897110 |
---|---|
Provider Name | Benjamin William Fitzer |
First Address | Newport News, VA 23606-4218 |
Second Address | Newport News, VA 23606-4218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 12/12/2007 |