Individual provider Active NPI

Matthew David Wittwer, DC

  • Chiropractor
  • Ponderay, ID
National Provider Identifier
1184268864
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-2147 Issued in ID
Practice address
477181 Highway 95 Ste B
Ponderay, ID 83852-5009
Phone
(208) 597-4033
NPI assigned
Nov 5, 2019
Last updated
Sep 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 34674 CA
Chiropractor 111N00000X CHIA-2147 ID Primary

Addresses

Primary practice location

477181 Highway 95 Ste B
Ponderay, ID 83852-5009

Mailing address

477181 Highway 95 Ste B
Ponderay, ID 83852-5009
Phone (208) 597-4033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221026001013 ID Practitioner - Chiropractic 0345673836 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

477181 Hwy 95
Suite B
Ponderay, ID 83852-5009
Phone (208) 597-4033

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIA-2152IDMDChiropractor
34674CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Saviano Chiropractic Center, Inc. Chiropractor CurrentSince Feb 22, 2023 Accepting new patients
Matthew Wittwer Chiropractic, P.L.L.C. Chiropractor CurrentSince Mar 16, 2022 Accepting new patients

Locations

390 El Camino Real
Ste I
Belmont, CA 94002
Phone (650) 444-0682

477181 Highway 95
Ste B
Ponderay, ID 83852
Phone (208) 597-4033

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1184268864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477181 HIGHWAY 95 STE B",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525009",
            "telephone_number": "208-597-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477181 HIGHWAY 95 STE B",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525009",
            "telephone_number": "208-597-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTWER",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-05",
        "last_updated": "2026-09-11",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "34674",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-2147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponderay, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.