Healthcare Provider Details

I. General information

NPI: 1649599481
Provider Name (Legal Business Name): WHITEKETTLE CHIROPRACTIC SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CAPE FEAR CIR SUITE 2
SNEADS FERRY NC
28460-9191
US

IV. Provider business mailing address

200 CAPE FEAR CIR SUITE 2
SNEADS FERRY NC
28460-9191
US

V. Phone/Fax

Practice location:
  • Phone: 910-327-0022
  • Fax: 910-327-0337
Mailing address:
  • Phone: 910-327-0022
  • Fax: 910-327-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3101
License Number StateNC

VIII. Authorized Official

Name: DR. BRETT WHITEKETTLE
Title or Position: OWNER
Credential: D.C.
Phone: 910-327-0022