Provider Demographics
NPI:1497978332
Name:WHITENACK, DANIEL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:WHITENACK
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 1:432 MARSH DUCK WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6556
Mailing Address - Country:US
Mailing Address - Phone:757-313-0199
Mailing Address - Fax:
Practice Address - Street 1:6202 N MILITARY HWY
Practice Address - Street 2:STE. D
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-5447
Practice Address - Country:US
Practice Address - Phone:757-855-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU82276Medicare ID - Type Unspecified