Provider Demographics
NPI:1386727295
Name:WITTIG, MICHAEL PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:WITTIG
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-0339
Mailing Address - Country:US
Mailing Address - Phone:973-584-9229
Mailing Address - Fax:973-584-1938
Practice Address - Street 1:172 LANDING RD
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1500
Practice Address - Country:US
Practice Address - Phone:973-584-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00229900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ451878Medicare ID - Type Unspecified