Healthcare Provider Details

I. General information

NPI: 1639311038
Provider Name (Legal Business Name): G ALLEN FITZNER DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 E CENTRAL AVE
WICHITA KS
67208-4202
US

IV. Provider business mailing address

5717 E CENTRAL AVE
WICHITA KS
67208-4202
US

V. Phone/Fax

Practice location:
  • Phone: 316-943-3208
  • Fax:
Mailing address:
  • Phone: 316-943-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number003191
License Number StateKS

VIII. Authorized Official

Name: DR. GLEN ALLEN FITZNER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 316-943-3208