Provider Demographics
NPI:1396900015
Name:WHITFORD CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:WHITFORD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-773-2534
Mailing Address - Street 1:625 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1500
Mailing Address - Country:US
Mailing Address - Phone:989-773-2534
Mailing Address - Fax:989-775-5074
Practice Address - Street 1:625 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1500
Practice Address - Country:US
Practice Address - Phone:989-773-2534
Practice Address - Fax:989-775-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C75051OtherBCBS
MI4404968Medicaid
MI0M08970Medicare UPIN