Provider Demographics
NPI:1538367743
Name:FITE, JAY-P T (DC)
Entity type:Individual
Prefix:DR
First Name:JAY-P
Middle Name:T
Last Name:FITE
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 1:25185 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2056
Mailing Address - Country:US
Mailing Address - Phone:440-777-2811
Mailing Address - Fax:
Practice Address - Street 1:25185 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2056
Practice Address - Country:US
Practice Address - Phone:440-777-2811
Practice Address - Fax:440-777-2819
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2947155Medicaid
OH4217572Medicare PIN