Provider Demographics
NPI:1790016632
Name:WITTE-MASON, STEPHANIE M (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:WITTE-MASON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2333 S M 76
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9380
Mailing Address - Country:US
Mailing Address - Phone:989-345-0010
Mailing Address - Fax:
Practice Address - Street 1:2333 S M 76
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661
Practice Address - Country:US
Practice Address - Phone:989-345-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007264111N00000X
MI2301009642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor