Basic Information
| Provider Information | |||||||||
| NPI: | 1861878928 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITLEDGE FAMILY CHIROPRACTIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2753 WISCONSIN ST | ||||||||
| Address2: | |||||||||
| City: | STURTEVANT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531771827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2628868600 | ||||||||
| FaxNumber: | 2628865342 | ||||||||
| Practice Location | |||||||||
| Address1: | 2753 WISCONSIN ST | ||||||||
| Address2: | |||||||||
| City: | STURTEVANT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531771827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2628868600 | ||||||||
| FaxNumber: | 2628865342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2015 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | WHITLEDGE | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CHIROPRACTIC PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2628868600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.C. | ||||||||
| NPICertificationDate: | 02/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 4961-12 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.