Provider Demographics
NPI:1992853287
Name:WITTWER, LANCE H (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:H
Last Name:WITTWER
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 1:2200 E PARRISH AVE
Mailing Address - Street 2:LL103 BLDGC
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-485-3772
Mailing Address - Fax:270-852-1631
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:LL103 BLDGC
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-485-3772
Practice Address - Fax:270-852-1631
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00000037077OtherANTHEM PIN NUMBER
KY85003820Medicaid
KYU54730Medicare UPIN
KY8903Medicare PIN