=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679776009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA ANN FITZWILLIAMS D.C., C.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 03/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 HIGHWAY 133 SUITE 270A
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81623-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-987-4470
-----------------------------------------------------
Fax | 970-797-1493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 HIGHWAY 133 SUITE 270A
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81623-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-987-4470
-----------------------------------------------------
Fax | 970-797-1493
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 0006444
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------