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General NPI Number Information
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NPI Number | 1619168614
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Entity Type | Organization
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Legal Business Name | WHITEAMIRE CLINIC PA INC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 2031 PARK AVE W
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City | ONTARIO
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State | OH
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Zip | 44906-2234
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Country | US
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Telephone | 419-529-2055
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Fax |
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Provider Business Mailing Address
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Address Line | 2031 PARK AVE W
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City | ONTARIO
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State | OH
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Zip | 44906-2234
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Country | US
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Telephone | 567-560-3179
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RUSTY V WHITEAMIRE
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Credential | D.O.
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Telephone | 567-560-3179
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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 | T47262
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License Number State | OH
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