Provider Demographics
NPI:1689740813
Name:WHITFORD, DENNIS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WAYNE
Last Name:WHITFORD
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 1:625 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1500
Mailing Address - Country:US
Mailing Address - Phone:989-773-2534
Mailing Address - Fax:989-775-5074
Practice Address - Street 1:625 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1500
Practice Address - Country:US
Practice Address - Phone:989-773-2534
Practice Address - Fax:989-775-5074
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4404968Medicaid
MI950C75051OtherBLUE CROSS BLUE SHIELD
MI950C75051OtherBLUE CROSS BLUE SHIELD