Provider Demographics
NPI:1932238771
Name:WHITMIRE, JOHN WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:WHITMIRE
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 1:1707 LANSING AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8732
Mailing Address - Country:US
Mailing Address - Phone:503-363-3483
Mailing Address - Fax:503-373-3685
Practice Address - Street 1:1707 LANSING AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8732
Practice Address - Country:US
Practice Address - Phone:503-363-3483
Practice Address - Fax:503-373-3685
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR115391Medicare UPIN