Provider Demographics
NPI:1790933471
Name:WHALEY-GREEN, SHAMEKA (DC)
Entity Type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:
Last Name:WHALEY-GREEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHAMEIKA
Other - Middle Name:
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1005 LANE ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2017
Mailing Address - Country:US
Mailing Address - Phone:843-696-8184
Mailing Address - Fax:
Practice Address - Street 1:615 S 2ND ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2157
Practice Address - Country:US
Practice Address - Phone:859-379-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00861001Medicare PIN