MEDICARE: CHARLES R WHITTINGTON CHIROPRACTIC LLC

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	1505	LA

General Provider Information

NPI Number	:	1760763361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES R WHITTINGTON CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1427 PETERMAN DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3433
Country	:	US
Telephone Number	:	318-445-8000
Fax Number	:	318-445-8800

Provider Business Practice Location Address
First Line	:	1427 PETERMAN DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3433
Country	:	US
Telephone Number	:	318-445-8000
Fax Number	:	318-445-8800

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	DR. CHARLES RUD WHITTINGTON
Credential	:	D.C.
Telephone Number	:	318-445-8000

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/09/2011

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