Provider Demographics
NPI:1174534432
Name:FITE, DEDRA A (DC)
Entity type:Individual
Prefix:DR
First Name:DEDRA
Middle Name:A
Last Name:FITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 SW GREEN OAKS BLVD
Mailing Address - Street 2:STE. 103
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1163
Mailing Address - Country:US
Mailing Address - Phone:817-483-3975
Mailing Address - Fax:817-478-8405
Practice Address - Street 1:5609 SW GREEN OAKS BLVD
Practice Address - Street 2:STE. 103
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1163
Practice Address - Country:US
Practice Address - Phone:817-483-3975
Practice Address - Fax:817-478-8405
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001883001Medicaid
TX001883001Medicaid
TXU59363Medicare UPIN