Provider Demographics
NPI:1275848756
Name:WHITTEN, DANIEL ALAN (LMBT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALAN
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WESTERN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6848
Mailing Address - Country:US
Mailing Address - Phone:910-346-0988
Mailing Address - Fax:910-346-0988
Practice Address - Street 1:411 WESTERN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6848
Practice Address - Country:US
Practice Address - Phone:910-346-0988
Practice Address - Fax:910-346-0988
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist