Provider Demographics
NPI:1548572332
Name:WENDEE R. WHITEHEAD PC
Entity Type:Organization
Organization Name:WENDEE R. WHITEHEAD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-451-0115
Mailing Address - Street 1:5775 AIRPORT BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-4218
Mailing Address - Country:US
Mailing Address - Phone:512-451-0115
Mailing Address - Fax:512-451-1208
Practice Address - Street 1:5775 AIRPORT BLVD
Practice Address - Street 2:STE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-4218
Practice Address - Country:US
Practice Address - Phone:512-451-0115
Practice Address - Fax:512-451-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603326Medicare PIN
TXTXB106887Medicare PIN
TXU09894Medicare UPIN