Provider Demographics
NPI:1346454535
Name:WHALLON, LOUIS FLETCHER
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:FLETCHER
Last Name:WHALLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71268
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90071-0268
Mailing Address - Country:US
Mailing Address - Phone:213-617-1052
Mailing Address - Fax:213-617-1072
Practice Address - Street 1:735 S FIGUEROA ST
Practice Address - Street 2:SUITE 127
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2571
Practice Address - Country:US
Practice Address - Phone:213-617-1052
Practice Address - Fax:213-617-1072
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07635Medicare UPIN