Provider Demographics
NPI:1750553228
Name:WHISTLN' DIXIE CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:WHISTLN' DIXIE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:O
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:435-688-9551
Mailing Address - Street 1:552 N DIXIE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5551
Mailing Address - Country:US
Mailing Address - Phone:435-688-9551
Mailing Address - Fax:
Practice Address - Street 1:552 N DIXIE DR
Practice Address - Street 2:SUITE C
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5551
Practice Address - Country:US
Practice Address - Phone:435-688-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4879417-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU94879Medicare UPIN