Healthcare Provider Details

I. General information

NPI: 1750104535
Provider Name (Legal Business Name): LONDYN CAROLL WITMER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17830 KENWOOD TRL
LAKEVILLE MN
55044-9492
US

IV. Provider business mailing address

17830 KENWOOD TRL
LAKEVILLE MN
55044-9492
US

V. Phone/Fax

Practice location:
  • Phone: 952-935-3345
  • Fax: 952-435-8895
Mailing address:
  • Phone: 952-435-3345
  • Fax: 952-435-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7275
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: