Provider Demographics
NPI:1104249515
Name:WITKOVITZ, BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:WITKOVITZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1604
Mailing Address - Country:US
Mailing Address - Phone:724-838-1350
Mailing Address - Fax:724-838-1358
Practice Address - Street 1:626 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1604
Practice Address - Country:US
Practice Address - Phone:724-838-1350
Practice Address - Fax:724-838-1358
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor