Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 08000206 | IN |
NPI | 1366494031 |
---|---|
Provider Name | Victor K Fitch |
First Address | Fort Wayne, IN 46815-4958 |
Second Address | Fort Wayne, IN 46805-4700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U19580 | (02) | IN |