MEDICARE: TIMOTHY W. DEWITT D,C., J.D.

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	5199	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55371	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1952437436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY W. DEWITT D,C., J.D.

Provider Business Mailing Address
First Line	:	9535 STATE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66111-1815
Country	:	US
Telephone Number	:	913-299-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	9535 STATE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66111-1815
Country	:	US
Telephone Number	:	913-299-0911
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/11/2008

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