Provider Demographics
NPI:1477691996
Name:WHITLOCK, WELLINGTON SIMMONS III (DC)
Entity Type:Individual
Prefix:DR
First Name:WELLINGTON
Middle Name:SIMMONS
Last Name:WHITLOCK
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:223 WILMINGTON W CHESTER PIKE STE 214
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9007
Mailing Address - Country:US
Mailing Address - Phone:844-365-7246
Mailing Address - Fax:610-361-7956
Practice Address - Street 1:1197 AIRPORT RD FL 2
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-6418
Practice Address - Country:US
Practice Address - Phone:844-365-7246
Practice Address - Fax:302-503-3432
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2399337000OtherGROUP IND BCBS
2399337000OtherGROUP IND BCBS
201925736OtherDE BCBS EIN
U57326Medicare UPIN