Provider Demographics
NPI:1073526638
Name:WITTNER, JEROME (DC)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:WITTNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CATALPA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2202
Mailing Address - Country:US
Mailing Address - Phone:845-651-1311
Mailing Address - Fax:845-561-9027
Practice Address - Street 1:5 CATALPA RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2202
Practice Address - Country:US
Practice Address - Phone:845-651-1311
Practice Address - Fax:845-561-9027
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X06951Medicare ID - Type Unspecified