Provider Demographics
NPI:1609947530
Name:WITTER, MATTHEW G (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:WITTER
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 1:3910 KIRBY DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4120
Mailing Address - Country:US
Mailing Address - Phone:713-522-2886
Mailing Address - Fax:713-522-2738
Practice Address - Street 1:3910 KIRBY DR
Practice Address - Street 2:SUITE 212
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4120
Practice Address - Country:US
Practice Address - Phone:713-522-2886
Practice Address - Fax:713-522-2738
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611616Medicare ID - Type Unspecified
TXV04213Medicare UPIN