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General NPI Number Information
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NPI Number | 1447220603
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Entity Type | Individual
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Provider Name | JAY JOSEPH FITZGERALD D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 109 1ST. ST. SW
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City | WAGNER
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State | SD
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Zip | 57380
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Country | US
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Telephone | 605-384-5419
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Fax | 605-384-5410
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Provider Business Mailing Address
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Address Line | 109 1ST. ST. SW PO BOX 758
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City | WAGNER
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State | SD
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Zip | 57380
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Country | US
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Telephone | 605-384-5419
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Fax | 605-384-5410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 840
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License Number State | SD
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