Provider Demographics
NPI:1134307960
Name:WHITTEN, YONATAN GAVRIEL (DC, CCWP)
Entity Type:Individual
Prefix:DR
First Name:YONATAN
Middle Name:GAVRIEL
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:DC, CCWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 VANDEVER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3322
Mailing Address - Country:US
Mailing Address - Phone:858-822-9136
Mailing Address - Fax:858-613-0127
Practice Address - Street 1:4446 VANDEVER AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3322
Practice Address - Country:US
Practice Address - Phone:858-822-9136
Practice Address - Fax:858-613-0127
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor