Provider Demographics
NPI:1417964883
Name:WHITELEY, PETER RANDOLPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:RANDOLPH
Last Name:WHITELEY
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 1:1042 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3341
Mailing Address - Country:US
Mailing Address - Phone:760-480-7555
Mailing Address - Fax:760-480-7593
Practice Address - Street 1:1042 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3341
Practice Address - Country:US
Practice Address - Phone:760-480-7555
Practice Address - Fax:760-480-7593
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-09-11
Deactivation Date:2012-07-11
Deactivation Code:
Reactivation Date:2012-09-11
Provider Licenses
StateLicense IDTaxonomies
CADC 25536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25536Medicare ID - Type Unspecified