Provider Demographics
NPI:1750681771
Name:WITT, LAURA L (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:L
Last Name:WITT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 190TH ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-9271
Mailing Address - Country:US
Mailing Address - Phone:563-249-5865
Mailing Address - Fax:
Practice Address - Street 1:3041 190TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-9271
Practice Address - Country:US
Practice Address - Phone:563-249-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor