Provider Demographics
NPI:1245961275
Name:KITTERMAN, WENDY L (DC)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:KITTERMAN
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 1:1355 N MAIN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5982
Mailing Address - Country:US
Mailing Address - Phone:801-872-8221
Mailing Address - Fax:
Practice Address - Street 1:1355 N MAIN ST STE 12
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5982
Practice Address - Country:US
Practice Address - Phone:801-589-2293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12619328-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor