=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760938831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITT CHIROPRACTIC CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2016
-----------------------------------------------------
Last Update Date | 08/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 MAIN ST STE C
-----------------------------------------------------
City | WEST LIBERTY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41472-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-743-3889
-----------------------------------------------------
Fax | 606-743-9536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 MAIN ST STE C
-----------------------------------------------------
City | WEST LIBERTY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41472-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-743-3889
-----------------------------------------------------
Fax | 606-743-9536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTHEW K WHITT
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 606-743-3889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5299
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------