Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 15988 | AR |
NPI | 1396249603 |
---|---|
Provider Name | Dr. Joshua Witter |
First Address | Pine Bluff, AR 71603-7139 |
Second Address | Little Rock, AR 72201-2041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 21/03/2018 |