MEDICARE: SCOTT ALAN WITTMER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH4079	FL
2	247200000X	Other Technician		FL

General Provider Information

NPI Number	:	1053396598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ALAN WITTMER DC

Provider Business Mailing Address
First Line	:	5435 LAKE HOWELL RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1033
Country	:	US
Telephone Number	:	407-677-7272
Fax Number	:	407-677-5298

Provider Business Practice Location Address
First Line	:	5435 LAKE HOWELL RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1033
Country	:	US
Telephone Number	:	407-677-7272
Fax Number	:	407-677-5298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	12/17/2012

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