MEDICARE: COURTNEY WHITEHEAD

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	14385	TX

General Provider Information

NPI Number	:	1619594413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY WHITEHEAD

Provider Business Mailing Address
First Line	:	100 KIOWA DR W STE 301
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-9584
Country	:	US
Telephone Number	:	940-668-8755
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 KIOWA DR W STE 301
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-9584
Country	:	US
Telephone Number	:	940-668-8755
Fax Number	:

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

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	06/29/2020

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Directions to “ COURTNEY WHITEHEAD ” Practice Location

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