Provider Demographics
NPI:1154369718
Name:FETZER, CHRISTY MARIE (DC)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:MARIE
Last Name:FETZER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:MARIE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1555 43RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3314
Mailing Address - Country:US
Mailing Address - Phone:701-356-6700
Mailing Address - Fax:701-356-6701
Practice Address - Street 1:1555 43RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3314
Practice Address - Country:US
Practice Address - Phone:701-356-6700
Practice Address - Fax:701-356-6701
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor