Provider Demographics
NPI:1205932324
Name:WHITEHEAD, WENDEE (DC)
Entity type:Individual
Prefix:
First Name:WENDEE
Middle Name:
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 1:281 PAINT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MC DADE
Mailing Address - State:TX
Mailing Address - Zip Code:78650-5361
Mailing Address - Country:US
Mailing Address - Phone:512-970-1595
Mailing Address - Fax:512-690-8845
Practice Address - Street 1:281 PAINT CREEK RD
Practice Address - Street 2:
Practice Address - City:MC DADE
Practice Address - State:TX
Practice Address - Zip Code:78650-5361
Practice Address - Country:US
Practice Address - Phone:512-970-1595
Practice Address - Fax:512-451-1208
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015588-01Medicaid
TXU09894Medicare UPIN
TX0015588-01Medicaid
TX0015588-01Medicaid