Provider Demographics
NPI:1386604627
Name:WHITTAKER, GAYLE ANNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:ANNETTE
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70-20 AUSTIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-544-8282
Mailing Address - Fax:718-544-3641
Practice Address - Street 1:70-20 AUSTIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-544-8282
Practice Address - Fax:718-544-3641
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0035171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T52448Medicare UPIN
NY03307Medicare ID - Type Unspecified