Provider Demographics
NPI:1376664235
Name:WHALEN, MARY A (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:WHALEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S HOWES ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2871
Mailing Address - Country:US
Mailing Address - Phone:970-493-7340
Mailing Address - Fax:970-416-1746
Practice Address - Street 1:420 S HOWES ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2871
Practice Address - Country:US
Practice Address - Phone:970-493-7340
Practice Address - Fax:970-416-1746
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC29083Medicare ID - Type Unspecified