Provider Demographics
NPI:1770073769
Name:WHICKER, CONNOR RUTLEDGE
Entity type:Individual
Prefix:MR
First Name:CONNOR
Middle Name:RUTLEDGE
Last Name:WHICKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14823 BISHOPSTONE CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8700
Mailing Address - Country:US
Mailing Address - Phone:704-650-8141
Mailing Address - Fax:
Practice Address - Street 1:14823 BISHOPSTONE CT
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8700
Practice Address - Country:US
Practice Address - Phone:704-650-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer