Provider Demographics
NPI:1750462933
Name:WHETSELL, JAY M (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:WHETSELL
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 1:102 SOUTH HWY 377
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227
Mailing Address - Country:US
Mailing Address - Phone:940-365-4000
Mailing Address - Fax:940-365-4003
Practice Address - Street 1:102 SOUTH HWY 377
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227
Practice Address - Country:US
Practice Address - Phone:940-365-4000
Practice Address - Fax:940-365-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609754Medicare ID - Type Unspecified
TXU90535Medicare UPIN