Healthcare Provider Details

I. General information

NPI: 1255423877
Provider Name (Legal Business Name): DAVID MARTIN WITTE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6861 UPPER AFTON RD SUITE 102
WOODBURY MN
55125-4417
US

IV. Provider business mailing address

6861 UPPER AFTON RD SUITE 102
WOODBURY MN
55125-4417
US

V. Phone/Fax

Practice location:
  • Phone: 651-739-1905
  • Fax: 651-738-5979
Mailing address:
  • Phone: 651-739-1905
  • Fax: 651-738-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1584
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: