MEDICARE: WITTMER CLINIC OF CHIROPRATIC PA

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	111NR0400X	Rehabilitation Chiropractor	CH4079	FL

General Provider Information

NPI Number	:	1902103625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITTMER CLINIC OF CHIROPRATIC PA

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	:	BILLING COORDINATOR
Name	:	SANDRA VAZQUEZ
Credential	:
Telephone Number	:	407-677-7272

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	06/24/2013

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