Provider Demographics
NPI:1760661573
Name:DEWITT CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DEWITT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-659-1667
Mailing Address - Street 1:306 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1404
Mailing Address - Country:US
Mailing Address - Phone:563-659-1667
Mailing Address - Fax:563-221-9218
Practice Address - Street 1:306 11TH ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1404
Practice Address - Country:US
Practice Address - Phone:563-659-1667
Practice Address - Fax:563-221-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7939Medicare PIN