Provider Demographics
NPI:1336164367
Name:WITT, KEVIN E (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:WITT
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 1:503 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A44WOtherMEDICARE BLUE CROSS BLUE SHIELD
TX00A44WOtherMEDICARE BLUE CROSS BLUE SHIELD
TX83G916Medicare ID - Type Unspecified