Provider Demographics
NPI:1962573501
Name:LITWIN, JASON WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:LITWIN
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:N162 EISENHOWER DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-6171
Mailing Address - Country:US
Mailing Address - Phone:920-734-7950
Mailing Address - Fax:920-734-7959
Practice Address - Street 1:N162 EISENHOWER DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-6171
Practice Address - Country:US
Practice Address - Phone:920-734-7950
Practice Address - Fax:920-734-7959
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3581-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU75631Medicare UPIN
WI000035834Medicare ID - Type Unspecified