Provider Demographics
NPI:1720109077
Name:WHITENBURG, OWEN BRADFORD (DC)
Entity Type:Individual
Prefix:MR
First Name:OWEN
Middle Name:BRADFORD
Last Name:WHITENBURG
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 1:3633 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2438
Mailing Address - Country:US
Mailing Address - Phone:361-225-2525
Mailing Address - Fax:361-225-2530
Practice Address - Street 1:3633 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2438
Practice Address - Country:US
Practice Address - Phone:361-225-2525
Practice Address - Fax:361-225-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5203111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation