Provider Demographics
NPI:1144585035
Name:WHITEHEAD CHIROPRACTIC HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:WHITEHEAD CHIROPRACTIC HEALTH CENTER, LLC
Other - Org Name:CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-202-0179
Mailing Address - Street 1:2400 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-5223
Mailing Address - Country:US
Mailing Address - Phone:806-435-6533
Mailing Address - Fax:806-435-2669
Practice Address - Street 1:2400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5223
Practice Address - Country:US
Practice Address - Phone:806-435-6533
Practice Address - Fax:806-435-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16600Medicare UPIN
TX8F1164Medicare PIN