Provider Demographics
NPI:1629126313
Name:WHITTAKER, JESSE P (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:P
Last Name:WHITTAKER
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 1:956 S FRY RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3062
Mailing Address - Country:US
Mailing Address - Phone:281-599-1800
Mailing Address - Fax:281-599-3710
Practice Address - Street 1:956 S FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3062
Practice Address - Country:US
Practice Address - Phone:281-599-1800
Practice Address - Fax:281-599-3710
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9335111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health