Provider Demographics
NPI:1780704502
Name:WITT, JOHN A (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
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 1:164 SMULL AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7842
Mailing Address - Country:US
Mailing Address - Phone:973-226-0793
Mailing Address - Fax:973-226-2351
Practice Address - Street 1:164 SMULL AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7842
Practice Address - Country:US
Practice Address - Phone:973-226-0793
Practice Address - Fax:973-226-2351
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00401800111N00000X
NYX006306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ672632Medicare PIN