Provider Demographics
NPI:1619167103
Name:WHALEN, CHARLES PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PATRICK
Last Name:WHALEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24865 5 MILE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3694
Mailing Address - Country:US
Mailing Address - Phone:313-592-4556
Mailing Address - Fax:313-592-4556
Practice Address - Street 1:24865 5 MILE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3694
Practice Address - Country:US
Practice Address - Phone:313-592-4556
Practice Address - Fax:313-592-4556
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004806111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist