MEDICARE: JAMES E. FITZPATRICK, D.C. PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH000000801	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61981	OTHER	WA	MEDICARE TIN

General Provider Information

NPI Number	:	1558614719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES E. FITZPATRICK, D.C. PS

Provider Business Mailing Address
First Line	:	465 RAINIER BLVD N
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2826
Country	:	US
Telephone Number	:	425-392-5321
Fax Number	:	425-837-3785

Provider Business Practice Location Address
First Line	:	465 RAINIER BLVD N
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2826
Country	:	US
Telephone Number	:	425-392-5321
Fax Number	:	425-837-3785

Authorized Official
Title or Position	:	OWNER
Name	:	VERA FITZPATRICK
Credential	:
Telephone Number	:	425-392-5321

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	03/22/2013

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