Provider Demographics
NPI:1528059458
Name:FITZSIMONS, DOMINIC (DC)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:FITZSIMONS
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 1:928 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-4901
Mailing Address - Country:US
Mailing Address - Phone:631-872-0150
Mailing Address - Fax:631-872-0551
Practice Address - Street 1:928 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-4901
Practice Address - Country:US
Practice Address - Phone:631-872-0150
Practice Address - Fax:631-872-0551
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004344 DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor