Provider Demographics
NPI:1750718672
Name:WITTMAN CHRIOPRACTIC GROUP
Entity type:Organization
Organization Name:WITTMAN CHRIOPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-966-6393
Mailing Address - Street 1:1001 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7254
Mailing Address - Country:US
Mailing Address - Phone:314-966-6393
Mailing Address - Fax:
Practice Address - Street 1:325 PIGGOTT LN
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-7557
Practice Address - Country:US
Practice Address - Phone:618-920-2570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty