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General NPI Number Information
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NPI Number | 1134577786
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Entity Type | Individual
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Provider Name | ADAM CHARLES WHITEHEAD LMT
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Gender | Male
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 305 N VALLEY WAY APT B4
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City | PALMER
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State | AK
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Zip | 99645-6182
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Country | US
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Telephone | 678-467-3259
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N VALLEY WAY APT B4
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City | PALMER
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State | AK
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Zip | 99645-6182
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Country | US
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Telephone | 678-467-3259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 106407
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT.0014003
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT012734
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT9338
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227040
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License Number State | AK
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