Provider Demographics
NPI:1891138855
Name:GARY W. WHITAKER, DC
Entity Type:Organization
Organization Name:GARY W. WHITAKER, DC
Other - Org Name:SHARYLAND CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-584-7388
Mailing Address - Street 1:2422 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3302
Mailing Address - Country:US
Mailing Address - Phone:956-584-7388
Mailing Address - Fax:956-584-7328
Practice Address - Street 1:2422 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3302
Practice Address - Country:US
Practice Address - Phone:956-584-7388
Practice Address - Fax:956-584-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty