Provider Demographics
NPI:1467513820
Name:WILLMITCH, MARTIN ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ANTHONY
Last Name:WILLMITCH
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 1:2901 WEST BUSCH BLVD.
Mailing Address - Street 2:#910
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618
Mailing Address - Country:US
Mailing Address - Phone:813-933-6481
Mailing Address - Fax:813-932-2229
Practice Address - Street 1:2901 WEST BUSCH BLVD.
Practice Address - Street 2:#910
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-933-6481
Practice Address - Fax:813-932-2229
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-7751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55906Medicare ID - Type Unspecified