Provider Demographics
NPI:1619021979
Name:WITT CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:WITT CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-267-8850
Mailing Address - Street 1:503 W EULESS BLVD
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4426
Mailing Address - Country:US
Mailing Address - Phone:817-267-8850
Mailing Address - Fax:817-545-9748
Practice Address - Street 1:503 W EULESS BLVD
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-4426
Practice Address - Country:US
Practice Address - Phone:817-267-8850
Practice Address - Fax:817-545-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A44WOtherBLUE CROSS BLUE SHIELD
TX00A44WOtherBLUE CROSS BLUE SHIELD