Provider Demographics
NPI:1639232945
Name:WITT, HANNAH (DC)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:FLAGLER
Mailing Address - State:CO
Mailing Address - Zip Code:80815-0321
Mailing Address - Country:US
Mailing Address - Phone:719-765-4757
Mailing Address - Fax:
Practice Address - Street 1:404 HIGH STREET
Practice Address - Street 2:
Practice Address - City:FLAGLER
Practice Address - State:CO
Practice Address - Zip Code:80815
Practice Address - Country:US
Practice Address - Phone:719-765-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO40839Medicare PIN