Healthcare Provider Details

I. General information

NPI: 1689097503
Provider Name (Legal Business Name): MICHAEL WHITAKER D.C., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 SE 182ND AVE
GRESHAM OR
97030-5083
US

IV. Provider business mailing address

4253 SE 182ND AVE
GRESHAM OR
97030-5083
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-5090
  • Fax: 503-489-2320
Mailing address:
  • Phone: 919-601-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5545
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: