Provider Demographics
NPI:1649375338
Name:TWIT, JERRY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALLEN
Last Name:TWIT
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 1:3125 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3269
Mailing Address - Country:US
Mailing Address - Phone:715-341-8222
Mailing Address - Fax:715-341-3663
Practice Address - Street 1:3125 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3269
Practice Address - Country:US
Practice Address - Phone:715-341-8222
Practice Address - Fax:715-341-3663
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38825600Medicaid
WI000275226Medicare ID - Type Unspecified
WI38825600Medicaid