Provider Demographics
NPI:1760763361
Name:CHARLES R WHITTINGTON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CHARLES R WHITTINGTON CHIROPRACTIC LLC
Other - Org Name:RUD AND WHITTINGTON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RUD
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-445-8000
Mailing Address - Street 1:1427 PETERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3433
Mailing Address - Country:US
Mailing Address - Phone:318-445-8000
Mailing Address - Fax:318-445-8800
Practice Address - Street 1:1427 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3433
Practice Address - Country:US
Practice Address - Phone:318-445-8000
Practice Address - Fax:318-445-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DL79Medicare PIN
LA1164665626Medicare UPIN