Provider Demographics
NPI:1164545380
Name:WHITTLESEY, JAMES BURKE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BURKE
Last Name:WHITTLESEY
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 1:7075 REDWOOD BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4136
Mailing Address - Country:US
Mailing Address - Phone:415-898-0889
Mailing Address - Fax:
Practice Address - Street 1:7075 REDWOOD BLVD STE E
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4136
Practice Address - Country:US
Practice Address - Phone:415-898-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN05809Medicare UPIN