Provider Demographics
NPI:1619000866
Name:WHITMER, MINA K (DC)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:K
Last Name:WHITMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 PASS RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3393
Mailing Address - Country:US
Mailing Address - Phone:228-374-5366
Mailing Address - Fax:228-374-5366
Practice Address - Street 1:1732 PASS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3393
Practice Address - Country:US
Practice Address - Phone:228-374-5366
Practice Address - Fax:228-374-5366
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02885Medicare UPIN