Provider Demographics
NPI:1124187976
Name:WHITLEY, PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:WHITLEY
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 1:69 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1611
Mailing Address - Country:US
Mailing Address - Phone:808-244-1161
Mailing Address - Fax:
Practice Address - Street 1:69 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1611
Practice Address - Country:US
Practice Address - Phone:808-244-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH56007Medicare UPIN
HIH56006Medicare ID - Type UnspecifiedGROUP NUMBER