Provider Demographics
NPI:1598955684
Name:WHITESIDE, HENRY B (LIC AC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:B
Last Name:WHITESIDE
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WATER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-1119
Mailing Address - Country:US
Mailing Address - Phone:413-625-9600
Mailing Address - Fax:
Practice Address - Street 1:TON WHITESIDE LIC. AC
Practice Address - Street 2:5 STATE ST., SUITE 6
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370-1119
Practice Address - Country:US
Practice Address - Phone:413-625-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist