MEDICARE: SOLEDAD CANYON CHIROPRACTIC-FITZPATRICK, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC23805	CA

General Provider Information

NPI Number	:	1174654370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLEDAD CANYON CHIROPRACTIC-FITZPATRICK, INC.

Provider Business Mailing Address
First Line	:	19004 SOLEDAD CANYON ROAD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3362
Country	:	US
Telephone Number	:	661-251-9004
Fax Number	:	661-251-9270

Provider Business Practice Location Address
First Line	:	19004 SOLEDAD CANYON ROAD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3362
Country	:	US
Telephone Number	:	661-251-9004
Fax Number	:	661-251-9270

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTINE L FITZPATRICK
Credential	:	D.C.
Telephone Number	:	661-251-9004

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	06/05/2018

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