Provider Demographics
NPI:1053396598
Name:WITTMER, SCOTT ALAN (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:WITTMER
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 1:5435 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1033
Mailing Address - Country:US
Mailing Address - Phone:407-677-7272
Mailing Address - Fax:407-677-5298
Practice Address - Street 1:5435 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1033
Practice Address - Country:US
Practice Address - Phone:407-677-7272
Practice Address - Fax:407-677-5298
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4079111N00000X
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU20836Medicare UPIN
FL6493260001Medicare NSC
FL88915Medicare PIN