Provider Demographics
NPI:1922547116
Name:WHITBY, JAKE WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:WAYNE
Last Name:WHITBY
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 1:1133 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-2725
Mailing Address - Country:US
Mailing Address - Phone:731-234-6208
Mailing Address - Fax:731-686-8635
Practice Address - Street 1:1133 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-2725
Practice Address - Country:US
Practice Address - Phone:731-234-6208
Practice Address - Fax:731-686-8635
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor