Provider Demographics
NPI:1649599481
Name:WHITEKETTLE CHIROPRACTIC SERVICES, PLLC
Entity Type:Organization
Organization Name:WHITEKETTLE CHIROPRACTIC SERVICES, PLLC
Other - Org Name:WHITEKETTLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEKETTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-327-0022
Mailing Address - Street 1:200 CAPE FEAR CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9191
Mailing Address - Country:US
Mailing Address - Phone:910-327-0022
Mailing Address - Fax:910-327-0337
Practice Address - Street 1:200 CAPE FEAR CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-9191
Practice Address - Country:US
Practice Address - Phone:910-327-0022
Practice Address - Fax:910-327-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085J3Medicaid
NC2455466OtherMEDICARE PROVIDER NUMBER
NC89085J3Medicaid