Provider Demographics
NPI:1346640422
Name:CHAMEIN CLARK-WITTER DC PC
Entity Type:Organization
Organization Name:CHAMEIN CLARK-WITTER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAMEIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLARK-WITTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-344-4926
Mailing Address - Street 1:1749 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2769
Mailing Address - Country:US
Mailing Address - Phone:563-344-4926
Mailing Address - Fax:563-344-8759
Practice Address - Street 1:1749 E 54TH STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-344-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty