Provider Demographics
NPI:1558475780
Name:WHITAKER, NATHAN NEAL (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:NEAL
Last Name:WHITAKER
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 1:6518 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7413
Mailing Address - Country:US
Mailing Address - Phone:281-370-4251
Mailing Address - Fax:281-370-1695
Practice Address - Street 1:6518 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7413
Practice Address - Country:US
Practice Address - Phone:281-370-4251
Practice Address - Fax:281-370-1695
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608216OtherBCBS PROVIDER #
TX74-3095119OtherTAX ID #
TXDC 9486OtherLICENSE #
TX74-3095119OtherTAX ID #
TX609804Medicare ID - Type Unspecified