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General NPI Number Information
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NPI Number | 1457838104
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Entity Type | Individual
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Provider Name | KENDRA LOUISE GRACE FITZKE DC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 2100 MAIN ST STE 202
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City | LONGMONT
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State | CO
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Zip | 80501-1590
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Country | US
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Telephone | 720-340-4435
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 MAIN ST STE 202
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City | LONGMONT
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State | CO
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Zip | 80501-1590
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Country | US
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Telephone | 720-340-4435
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR.0008437
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License Number State | CO
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