Provider Demographics
NPI:1134577786
Name:WHITEHEAD, ADAM CHARLES (LMT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:CHARLES
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N VALLEY WAY APT B4
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6182
Mailing Address - Country:US
Mailing Address - Phone:678-467-3259
Mailing Address - Fax:
Practice Address - Street 1:305 N VALLEY WAY APT B4
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6182
Practice Address - Country:US
Practice Address - Phone:678-467-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106407174400000X
COMT.0014003225700000X
GAMT012734225700000X
TNMT9338225700000X
AK227040225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist