Provider Demographics
NPI:1265760334
Name:WHITEHEAD, JOHN R (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11488 OPEN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8790
Mailing Address - Country:US
Mailing Address - Phone:801-455-5858
Mailing Address - Fax:801-302-1233
Practice Address - Street 1:11488 OPEN VIEW LN
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8790
Practice Address - Country:US
Practice Address - Phone:801-455-5858
Practice Address - Fax:801-302-1233
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48622601201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor