Provider Demographics
NPI:1316083892
Name:WHITBECK CHIROPRACTIC CLINIC P.C.
Entity type:Organization
Organization Name:WHITBECK CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-867-4800
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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0240830OtherBLUE CROSS BLUE SHIELD
AZ111474142475OtherHUMANA
AZP1639999OtherOXFORD HEALTH PLAN
AZAZ8753OtherHEALTHNET
AZ0004566792OtherAETNA
AZZDC4970Medicare PIN