Healthcare Provider Details

I. General information

NPI: 1992009005
Provider Name (Legal Business Name): JON PAUL FRITZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 COUNTY ROAD 220 SUITE 165
FLEMING ISLAND FL
32003-4908
US

IV. Provider business mailing address

1605 COUNTY ROAD 220 STE165
FLEMING ISLAND FL
32003-4908
US

V. Phone/Fax

Practice location:
  • Phone: 904-425-9060
  • Fax: 904-425-9061
Mailing address:
  • Phone: 904-425-9060
  • Fax: 904-425-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: