Healthcare Provider Details

I. General information

NPI: 1447416656
Provider Name (Legal Business Name): NANCY A. FITZGERALD D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-5615 LUHIA ST
KAILUA KONA HI
96740-3622
US

IV. Provider business mailing address

74-5615 LUHIA ST
KAILUA KONA HI
96740-3622
US

V. Phone/Fax

Practice location:
  • Phone: 808-640-8464
  • Fax:
Mailing address:
  • Phone: 808-640-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1047
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: