Provider Demographics
NPI:1871587238
Name:WHITAKER, JANE S (DC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:S
Last Name:WHITAKER
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 1:247 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2405
Mailing Address - Country:US
Mailing Address - Phone:631-878-6262
Mailing Address - Fax:631-878-3617
Practice Address - Street 1:247 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2405
Practice Address - Country:US
Practice Address - Phone:631-878-6262
Practice Address - Fax:631-878-3617
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0046661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT53001Medicare UPIN
NYX2751Medicare PIN