Healthcare Provider Details

I. General information

NPI: 1790016632
Provider Name (Legal Business Name): STEPHANIE M WITTE-MASON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE MARIE WITTE DC

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 08/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 S M 76
WEST BRANCH MI
48661
US

IV. Provider business mailing address

2333 S M 76
WEST BRANCH MI
48661-9380
US

V. Phone/Fax

Practice location:
  • Phone: 989-345-0010
  • Fax:
Mailing address:
  • Phone: 989-345-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007264
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: