Provider Demographics
NPI:1346382538
Name:WITTE, JEFFERY S, (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:S,
Last Name:WITTE
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 1:3006 WOODVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-1428
Mailing Address - Country:US
Mailing Address - Phone:419-691-3133
Mailing Address - Fax:419-691-3133
Practice Address - Street 1:3006 WOODVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1428
Practice Address - Country:US
Practice Address - Phone:419-691-3133
Practice Address - Fax:419-691-3133
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor