Healthcare Provider Details

I. General information

NPI: 1366494031
Provider Name (Legal Business Name): VICTOR K FITCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 E STATE BLVD
FORT WAYNE IN
46805-4700
US

IV. Provider business mailing address

4511 TRIER RD
FORT WAYNE IN
46815-4958
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-7493
  • Fax: 260-471-6935
Mailing address:
  • Phone: 260-485-9261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number08000206
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: