Provider Demographics
NPI:1891830287
Name:WHITEHEAD, JANELLE DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:DAWN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 S MAIN ST
Mailing Address - Street 2:STE 305
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7514
Mailing Address - Country:US
Mailing Address - Phone:817-251-9828
Mailing Address - Fax:817-251-9829
Practice Address - Street 1:1340 S MAIN ST
Practice Address - Street 2:STE 305
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7514
Practice Address - Country:US
Practice Address - Phone:817-251-9828
Practice Address - Fax:817-251-9829
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148302OtherMEDICARE PTAN PERSONAL