Provider Demographics
NPI:1629160288
Name:WITKOWSKI-KIRKPATRICK, TINA KAY (DC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:KAY
Last Name:WITKOWSKI-KIRKPATRICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:TINA
Other - Middle Name:KAY
Other - Last Name:WITKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:506 N RIDGEWAY SUITE B
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033
Mailing Address - Country:US
Mailing Address - Phone:817-774-2225
Mailing Address - Fax:817-556-9999
Practice Address - Street 1:506 N RIDGEWAY SUITE B
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033
Practice Address - Country:US
Practice Address - Phone:817-774-2225
Practice Address - Fax:817-556-9999
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81287Medicare UPIN
TX609411Medicare ID - Type Unspecified