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General NPI Number Information
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NPI Number | 1104190503
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Entity Type | Organization
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Legal Business Name | PATRICK B. WHITAKER, D.C., P.C.
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 129 PHELPS AVE SUITE 316
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City | ROCKFORD
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State | IL
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Zip | 61108-2453
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Country | US
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Telephone | 815-229-5568
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Fax | 815-229-0942
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Provider Business Mailing Address
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Address Line | 129 PHELPS AVE SUITE 316
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City | ROCKFORD
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State | IL
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Zip | 61108-2453
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Country | US
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Telephone | 815-229-5568
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Fax | 815-229-0942
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK B WHITAKER
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Credential | D.C.
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Telephone | 815-229-5568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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