Provider Demographics
NPI:1164665626
Name:WHITTINGTON, CHARLES RUD (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RUD
Last Name:WHITTINGTON
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 1:1427 PETERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3433
Mailing Address - Country:US
Mailing Address - Phone:318-445-8000
Mailing Address - Fax:318-445-8000
Practice Address - Street 1:1427 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3433
Practice Address - Country:US
Practice Address - Phone:318-445-8000
Practice Address - Fax:318-445-8000
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor