Provider Demographics
NPI:1659426245
Name:WHITTAKER, II, LOVEROUS (DC)
Entity Type:Individual
Prefix:DR
First Name:LOVEROUS
Middle Name:
Last Name:WHITTAKER, II
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 1:9001 ANNA ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1625
Mailing Address - Country:US
Mailing Address - Phone:972-898-9523
Mailing Address - Fax:
Practice Address - Street 1:9001 ANNA ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1625
Practice Address - Country:US
Practice Address - Phone:972-898-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9834111N00000X
FL8132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor