Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2488 | WI |
NPI | 1699767368 |
---|---|
Provider Name | Stephen R Dewitt |
First Address | Madison, WI 53711-1888 |
Second Address | Madison, WI 53711-1888 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 08/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38844800 | (05) | WI |
T91933 | (02) | WI |