Provider Demographics
NPI:1760804710
Name:WITEK, JEFFREY (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WITEK
Suffix:
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 1:396 VIRGINIA PL
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-4924
Mailing Address - Country:US
Mailing Address - Phone:630-289-1181
Mailing Address - Fax:
Practice Address - Street 1:825 S. ILLINOIS ROUTE 59
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-1629
Practice Address - Country:US
Practice Address - Phone:630-289-1181
Practice Address - Fax:630-289-1186
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor