Provider Demographics
NPI:1336477405
Name:LAURA WITTENBERG CHIROPRACTOR, PC
Entity Type:Organization
Organization Name:LAURA WITTENBERG CHIROPRACTOR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:MCCASLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-487-0600
Mailing Address - Street 1:413 WAUKAZOO AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2619
Mailing Address - Country:US
Mailing Address - Phone:231-487-0600
Mailing Address - Fax:231-487-0601
Practice Address - Street 1:413 WAUKAZOO AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2619
Practice Address - Country:US
Practice Address - Phone:231-487-0600
Practice Address - Fax:231-487-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION57160Medicare UPIN