Provider Demographics
NPI:1891963815
Name:WHITTLE CHIROPRACTIC CTR., INC.
Entity type:Organization
Organization Name:WHITTLE CHIROPRACTIC CTR., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-218-1166
Mailing Address - Street 1:3590 CHEROKEE ST NW
Mailing Address - Street 2:STE. 401
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5930
Mailing Address - Country:US
Mailing Address - Phone:770-218-1166
Mailing Address - Fax:770-218-1006
Practice Address - Street 1:3590 CHEROKEE ST NW
Practice Address - Street 2:STE. 401
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5930
Practice Address - Country:US
Practice Address - Phone:770-218-1166
Practice Address - Fax:770-218-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU82659Medicare UPIN
GA35ZCGDFMedicare PIN