Provider Demographics
NPI:1801055025
Name:WILLUWEIT, CLINT JORDAN (DC)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:JORDAN
Last Name:WILLUWEIT
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:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-0608
Mailing Address - Country:US
Mailing Address - Phone:605-842-1588
Mailing Address - Fax:605-842-1378
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-1426
Practice Address - Country:US
Practice Address - Phone:605-842-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor