Provider Demographics
NPI:1952437436
Name:DEWITT, TIMOTHY W (D,C, JD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:DEWITT
Suffix:
Gender:M
Credentials:D,C, JD
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:WADE
Other - Last Name:DZEDULEVICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9535 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66111-1815
Mailing Address - Country:US
Mailing Address - Phone:913-299-0911
Mailing Address - Fax:
Practice Address - Street 1:9535 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111-1815
Practice Address - Country:US
Practice Address - Phone:913-299-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55371OtherBLUE CROSS
FL55371OtherBLUE CROSS
55371Medicare ID - Type Unspecified