Healthcare Provider Details

I. General information

NPI: 1396772323
Provider Name (Legal Business Name): DAMON MAX WHITAKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 OKLAHOMA AVE
TRENTON MO
64683-3405
US

IV. Provider business mailing address

3309 LAKE TRENTON DR
TRENTON MO
64683-3228
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-3500
  • Fax: 660-359-3511
Mailing address:
  • Phone: 660-359-3500
  • Fax: 660-359-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2005035875
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: