Provider Demographics
NPI:1003214719
Name:WHITEHOUSE, BRANDI (DC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:WHITEHOUSE
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 1:2336 BERNARD RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1169
Mailing Address - Country:US
Mailing Address - Phone:404-457-4392
Mailing Address - Fax:
Practice Address - Street 1:4499 HIGHWAY 40 STE C
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-9402
Practice Address - Country:US
Practice Address - Phone:912-882-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor