Provider Demographics
NPI:1336573963
Name:WITT, KELVIN DAVES (DC)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:DAVES
Last Name:WITT
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 1:2001 S SHIELDS ST STE H101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1827
Mailing Address - Country:US
Mailing Address - Phone:970-494-1000
Mailing Address - Fax:
Practice Address - Street 1:2001 S SHIELDS ST STE H101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1827
Practice Address - Country:US
Practice Address - Phone:970-494-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2015-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor