Provider Demographics
NPI:1750252698
Name:DEMEIS-DEWITT, DIVINO (DC)
Entity type:Individual
Prefix:
First Name:DIVINO
Middle Name:
Last Name:DEMEIS-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 1:10310 W BEARDSLEY RD UNIT 1029
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0004
Mailing Address - Country:US
Mailing Address - Phone:815-412-5855
Mailing Address - Fax:
Practice Address - Street 1:18301 N 79TH AVE STE C133
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8471
Practice Address - Country:US
Practice Address - Phone:815-412-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty