Michael Dennis Fitzpatrick, D.C.
Individual provider Active NPI Chiropractor · Waller, TX
NPI 1982852869 · NPPES record last updated Sep 15, 2010
Key facts
- NPI
- 1982852869
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5749 (TX)
- Practice address
- 1225 Farr St
Waller, TX 77484-8486 - Phone
- (936) 931-5100
- Fax
- (936) 372-5005
- NPI assigned
- Sep 3, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 1991
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
250 E Colorado St
La Grange, TX 78945-2244
Phone (979) 968-3340
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090713000036 | TX | Practitioner - Chiropractic | 1557413127 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5749 | TX | MD | Behavioral Analyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5749 | TX | Yes |
Addresses
Primary practice location
1225 Farr St
Waller, TX 77484-8486
Mailing address
1225 Farr
Waller, TX 77484-8582
Phone (936) 931-5100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 088417302 | Medicaid | TX |
Other providers in Waller, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.