Provider Demographics
NPI:1245593052
Name:WHITMIRE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:WHITMIRE CHIROPRACTIC PC
Other - Org Name:WHITMIRE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN-PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WHITMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-362-1002
Mailing Address - Street 1:1126 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2933
Mailing Address - Country:US
Mailing Address - Phone:503-362-1002
Mailing Address - Fax:503-362-1006
Practice Address - Street 1:1126 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2933
Practice Address - Country:US
Practice Address - Phone:503-362-1002
Practice Address - Fax:503-362-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4094111N00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548550981Medicare NSC