Provider Demographics
NPI:1891020954
Name:WHITELEY CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:WHITELEY CHIROPRACTIC CENTER, INC.
Other - Org Name:WHITELEY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:WHITELEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-480-7555
Mailing Address - Street 1:1042 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3341
Mailing Address - Country:US
Mailing Address - Phone:760-480-7555
Mailing Address - Fax:760-480-7593
Practice Address - Street 1:1042 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3341
Practice Address - Country:US
Practice Address - Phone:760-480-7555
Practice Address - Fax:760-480-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25536Medicare UPIN