Provider Demographics
NPI:1881651719
Name:WHETTON, GEORGE RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RUSSELL
Last Name:WHETTON
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 1:57407 29 PALMS HWY STE A
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2907
Mailing Address - Country:US
Mailing Address - Phone:760-369-0593
Mailing Address - Fax:760-369-1097
Practice Address - Street 1:57407 29 PALMS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2907
Practice Address - Country:US
Practice Address - Phone:760-369-0593
Practice Address - Fax:760-369-1097
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110565-1202111N00000X
CA11533111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52825677903001OtherBLUE CROSS
UT360947200OtherMAIL HANDLERS
UTD5227Medicaid
UT000056003Medicare ID - Type UnspecifiedMEDICARE
UTD5227Medicaid