Provider Demographics
NPI:1760657373
Name:DEWITT, JOHN DONOVAN II (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONOVAN
Last Name:DEWITT
Suffix:II
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 1:1220 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2248
Mailing Address - Country:US
Mailing Address - Phone:208-884-5000
Mailing Address - Fax:
Practice Address - Street 1:1220 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2248
Practice Address - Country:US
Practice Address - Phone:208-884-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30867111N00000X
IDCHIA-2355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor