Provider Demographics
NPI:1346348794
Name:WHITEAMIRE, RUSTY V (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSTY
Middle Name:V
Last Name:WHITEAMIRE
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 1:2031 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2234
Mailing Address - Country:US
Mailing Address - Phone:419-631-1072
Mailing Address - Fax:
Practice Address - Street 1:2031 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2234
Practice Address - Country:US
Practice Address - Phone:419-529-2055
Practice Address - Fax:419-529-6085
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0872111N00000X
OHDC-00872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWH9297991Medicare ID - Type Unspecified
OHWH0491662Medicare ID - Type Unspecified