Provider Demographics
NPI:1144350307
Name:WILLHITE, KEVIN SHAWN (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SHAWN
Last Name:WILLHITE
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 1:1810 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6562
Mailing Address - Country:US
Mailing Address - Phone:432-570-8228
Mailing Address - Fax:
Practice Address - Street 1:1810 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6562
Practice Address - Country:US
Practice Address - Phone:432-570-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609670Medicare ID - Type Unspecified
TXU87805Medicare UPIN