Provider Demographics
NPI:1508917634
Name:WITMER, CHRISTOPHER TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:WITMER
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 1:1324 ALLEGHENY STREET
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740
Mailing Address - Country:US
Mailing Address - Phone:570-398-7223
Mailing Address - Fax:570-398-9777
Practice Address - Street 1:1324 ALLEGHENY STREET
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740
Practice Address - Country:US
Practice Address - Phone:570-398-7223
Practice Address - Fax:570-398-9777
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007518L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84818Medicare UPIN
063761Medicare ID - Type Unspecified