Individual
BRET WHITTAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.,D.A.B.C.O.
Contact information
Practice address
458 S MAIN ST, RICHFIELD, UT 84701-2846
(435) 896-5656
(435) 896-2842
Mailing address
458 S MAIN ST, RICHFIELD, UT 84701-2846
(435) 896-5656
(435) 896-2842
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
172697-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000069844
MEDICARE PTAN
—
01
—
190502300
FECA-OWCP
UT
Enumeration date
08/17/2005
Last updated
07/08/2014
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