MEDICARE: G ALLEN FITZNER DC PA

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	111NN1001X	Nutrition Chiropractor	003191	KS

General Provider Information

NPI Number	:	1639311038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G ALLEN FITZNER DC PA

Provider Business Mailing Address
First Line	:	5717 E CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67208-4202
Country	:	US
Telephone Number	:	316-943-3208
Fax Number	:

Provider Business Practice Location Address
First Line	:	5717 E CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67208-4202
Country	:	US
Telephone Number	:	316-943-3208
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLEN ALLEN FITZNER
Credential	:	D.C.
Telephone Number	:	316-943-3208

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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