Provider Demographics
NPI:1710152012
Name:DOWNTOWN DEWITT CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:DOWNTOWN DEWITT CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-668-0411
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8946
Mailing Address - Country:US
Mailing Address - Phone:517-668-0411
Mailing Address - Fax:517-669-5121
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8946
Practice Address - Country:US
Practice Address - Phone:517-668-0411
Practice Address - Fax:517-669-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1010973Medicaid
MI1010973Medicaid