Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC4620 | TX |
N | 111NI0013X | Independent Medical Examiner | DC4620 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | DC4620 | TX |
N | 111NS0005X | Chiropractic Sports Physician | DC4620 | TX |
N | 111NX0100X | Occupational Health | DC4620 | TX |
NPI | 1720429061 |
---|---|
Provider Name | Dr. Gwendolyn Whigham |
First Address | Houston, TX 77096-4564 |
Second Address | Houston, TX 77096-4564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 15/07/2013 |