Provider Demographics
NPI:1245337203
Name:WHITTAKER, ROBERT A (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:WHITTAKER
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 1:905 BELLEFONTE RD
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-2005
Mailing Address - Country:US
Mailing Address - Phone:606-836-2522
Mailing Address - Fax:606-836-0257
Practice Address - Street 1:905 BELLEFONTE RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-2005
Practice Address - Country:US
Practice Address - Phone:606-836-2522
Practice Address - Fax:606-836-0257
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611142054OtherTAX IDENTIFICATION
KY6052201Medicare ID - Type Unspecified
KYT54504Medicare UPIN