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General NPI Number Information
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NPI Number | 1750252698
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Entity Type | Individual
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Provider Name | DIVINO DEMEIS-DEWITT DC
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Gender | Male
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 18301 N 79TH AVE STE C133
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City | GLENDALE
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State | AZ
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Zip | 85308-8471
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Country | US
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Telephone | 815-412-5855
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Fax |
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Provider Business Mailing Address
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Address Line | 10310 W BEARDSLEY RD UNIT 1029
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City | PEORIA
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State | AZ
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Zip | 85382-0004
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Country | US
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Telephone | 815-412-5855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9373
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License Number State | AZ
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