Provider Demographics
NPI:1124209945
Name:DR.GARY W. WHITAKER, LLC
Entity Type:Organization
Organization Name:DR.GARY W. WHITAKER, LLC
Other - Org Name:WHITAKER HEALTH ENTERPRISES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-584-7388
Mailing Address - Street 1:2422 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3302
Mailing Address - Country:US
Mailing Address - Phone:956-584-7388
Mailing Address - Fax:956-584-7328
Practice Address - Street 1:2422 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3302
Practice Address - Country:US
Practice Address - Phone:956-584-7388
Practice Address - Fax:956-584-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00231ZMedicare PIN