Healthcare Provider Details

I. General information

NPI: 1437110145
Provider Name (Legal Business Name): CHARLES F WHITNEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 4TH ST NW
BOWMAN ND
58623-4805
US

IV. Provider business mailing address

PO BOX 176
BOWMAN ND
58623-0176
US

V. Phone/Fax

Practice location:
  • Phone: 701-523-3239
  • Fax: 701-523-3239
Mailing address:
  • Phone: 701-523-3239
  • Fax: 701-523-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number439
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: