Provider Demographics
NPI:1144334681
Name:WHALEN, JON A (DC)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:A
Last Name:WHALEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 SEMINOLE TRL
Mailing Address - Street 2:STE U3
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22923-2836
Mailing Address - Country:US
Mailing Address - Phone:434-985-8100
Mailing Address - Fax:434-985-8123
Practice Address - Street 1:6420 SEMINOLE TRL
Practice Address - Street 2:STE U3
Practice Address - City:BARBOURSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22923-2836
Practice Address - Country:US
Practice Address - Phone:434-985-8100
Practice Address - Fax:434-985-8123
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA068249OtherTRIGON
VA6980050/002OtherCIGNA
VA350000408Medicare ID - Type Unspecified
VAU35627Medicare UPIN