Provider Demographics
NPI:1104095371
Name:FITZGERALD, ELIZABETH ANN (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
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 1:3631 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-1937
Mailing Address - Country:US
Mailing Address - Phone:515-314-3419
Mailing Address - Fax:
Practice Address - Street 1:8814 SWANSON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6910
Practice Address - Country:US
Practice Address - Phone:515-314-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor