Provider Demographics
NPI:1063606382
Name:WHITBECK, BRUCE LEE (DC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:LEE
Last Name:WHITBECK
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 1:4910 E GREENWAY RD
Mailing Address - Street 2:#4
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1653
Mailing Address - Country:US
Mailing Address - Phone:602-867-4800
Mailing Address - Fax:602-867-7171
Practice Address - Street 1:4910 E GREENWAY RD
Practice Address - Street 2:#4
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1653
Practice Address - Country:US
Practice Address - Phone:602-867-4800
Practice Address - Fax:602-867-7171
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDC4970Medicare PIN