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Organization
DEWITT CHIROPRACTIC, PLLC
Active
Organization
DEWITT CHIROPRACTIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADFORD J DEWITT D.C. (OWNER)
(228) 832-0846
Entity
Organization
Contact information
Practice address
15465 OAK LN, SUITE 100B, GULFPORT, MS 39503-2663
(228) 832-0846
(228) 832-0856
Mailing address
15465 OAK LN, SUITE 100B, GULFPORT, MS 39503-2663
(228) 832-0846
(228) 832-0856
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1145
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302I354509
MEDICARE
MS
01
—
9194329
AETNA
MS
01
—
93014524
UNITED HEALTH CARE
MS
05
—
953596
—
MS
Enumeration date
03/25/2010
Last updated
08/13/2013
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