MEDICARE: DR. CRYSTAL IOLA WHITAKER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2005035876	MO

General Provider Information

NPI Number	:	1033146063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL IOLA WHITAKER D.C.

Provider Business Mailing Address
First Line	:	3309 LAKE TRENTON DR
Second Line	:
City	:	TRENTON
State	:	MO
Zip	:	64683-3228
Country	:	US
Telephone Number	:	660-359-3500
Fax Number	:	660-359-3511

Provider Business Practice Location Address
First Line	:	2910 OKLAHOMA AVE
Second Line	:
City	:	TRENTON
State	:	MO
Zip	:	64683-3405
Country	:	US
Telephone Number	:	660-359-3500
Fax Number	:	660-359-3511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	05/27/2008

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