Provider Demographics
NPI:1699767368
Name:DEWITT, STEPHEN R (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:DEWITT
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 1:105 CLARMAR DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2675
Mailing Address - Country:US
Mailing Address - Phone:608-318-5929
Mailing Address - Fax:608-318-5922
Practice Address - Street 1:2702 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1888
Practice Address - Country:US
Practice Address - Phone:608-231-3370
Practice Address - Fax:608-231-1547
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2488111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38844800Medicaid
WIT91933Medicare UPIN
WI000135155Medicare ID - Type Unspecified