Individual
MR. CLINTON ALLEN WHITTENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
520 JERICHO RD., LA GRANGE, KY 40031-0101
(502) 222-7623
Mailing address
PO BOX 101, LA GRANGE, KY 40031-0101
(502) 222-7623
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
KY0384
KY
Other
Enumeration date
10/14/2009
Last updated
10/14/2009
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