Provider Demographics
NPI:1043305063
Name:WHITFIELD, JODI L (DC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S HAGADORN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-324-5433
Mailing Address - Fax:517-324-9594
Practice Address - Street 1:4500 S HAGADORN
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-324-5433
Practice Address - Fax:517-324-9594
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1009991OtherMCLAREN
MI4570495Medicaid
MI4570495Medicaid
MION85010002Medicare ID - Type Unspecified