Healthcare Provider Details

I. General information

NPI: 1003214719
Provider Name (Legal Business Name): BRANDI WHITEHOUSE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 SADLER RD # 1077
FERNANDINA BEACH FL
32034-4434
US

IV. Provider business mailing address

334 WESTBRIDGE LN
CANTON GA
30114-6337
US

V. Phone/Fax

Practice location:
  • Phone: 404-457-4392
  • Fax:
Mailing address:
  • Phone: 404-457-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: