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Individual

JOHN WITKOWSKI

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
1020 FOREST AVE, PORTLAND, ME 04103-3333
(207) 797-4815
(207) 797-4813
Mailing address
1020 FOREST AVE, PORTLAND, ME 04103-3333
(207) 797-4815
(207) 797-4813

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
525
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000703
ANTHEM BCBS
05
1169300000
ME
Enumeration date
09/13/2005
Last updated
07/08/2007
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