MEDICARE: JEREMY WHIDDEN

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	12229	FL

General Provider Information

NPI Number	:	1194246306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY WHIDDEN

Provider Business Mailing Address
First Line	:	501 HARBOR BLVD STE C
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 HARBOR BLVD STE C
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2348
Country	:	US
Telephone Number	:	850-654-1850
Fax Number	:

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

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	06/28/2017

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Directions to “ JEREMY WHIDDEN ” Practice Location

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