Provider Demographics
NPI:1215106208
Name:WITKOP, NATHAN HARRY (DC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:HARRY
Last Name:WITKOP
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 1:9 FINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1038
Mailing Address - Country:US
Mailing Address - Phone:518-483-2804
Mailing Address - Fax:518-483-2872
Practice Address - Street 1:9 FINNEY BLVD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1038
Practice Address - Country:US
Practice Address - Phone:518-483-2804
Practice Address - Fax:518-483-2872
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor