Healthcare Provider Details

I. General information

NPI: 1053396598
Provider Name (Legal Business Name): SCOTT ALAN WITTMER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 LAKE HOWELL RD
WINTER PARK FL
32792-1033
US

IV. Provider business mailing address

5435 LAKE HOWELL RD
WINTER PARK FL
32792-1033
US

V. Phone/Fax

Practice location:
  • Phone: 407-677-7272
  • Fax: 407-677-5298
Mailing address:
  • Phone: 407-677-7272
  • Fax: 407-677-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4079
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: