MEDICARE: WHITFORD CHIROPRACTIC CLINIC

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	2301006110	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0C75051	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396900015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITFORD CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	625 N MAIN ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-1500
Country	:	US
Telephone Number	:	989-773-2534
Fax Number	:	989-775-5074

Provider Business Practice Location Address
First Line	:	625 N MAIN ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-1500
Country	:	US
Telephone Number	:	989-773-2534
Fax Number	:	989-775-5074

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENNIS W WHITFORD
Credential	:	D.C.
Telephone Number	:	989-773-2534

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	10/13/2009

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