Provider Demographics
NPI:1487297123
Name:WITTORF, SHELBY (DC)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:WITTORF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16126 JOE MORAN RD
Mailing Address - Street 2:
Mailing Address - City:KILN
Mailing Address - State:MS
Mailing Address - Zip Code:39556-8299
Mailing Address - Country:US
Mailing Address - Phone:228-216-5116
Mailing Address - Fax:
Practice Address - Street 1:370 COURTHOUSE RD STE 101
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1889
Practice Address - Country:US
Practice Address - Phone:228-241-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor