Provider Demographics
NPI:1730216169
Name:WHITTAKER, DEBORAH DEBASTIANI (DC)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:DEBASTIANI
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:DEBASTIANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:130 COLLEGE ST
Mailing Address - Street 2:SUITE 50
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1493
Mailing Address - Country:US
Mailing Address - Phone:413-532-1177
Mailing Address - Fax:413-532-3466
Practice Address - Street 1:130 COLLEGE ST
Practice Address - Street 2:SUITE 50
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1493
Practice Address - Country:US
Practice Address - Phone:413-532-1177
Practice Address - Fax:413-532-3466
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA439552OtherBLUE CROSS BLUE SHIELD
MA445064Medicare ID - Type Unspecified