MEDICARE: WHITE CHIROPRACTIC HEALTH CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301300303	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0N84770	OTHER		MEDICARE PLUS BLUE

General Provider Information

NPI Number	:	1447455092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE CHIROPRACTIC HEALTH CARE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 298
Second Line	:	1120 CLEAVER RD
City	:	CARO
State	:	MI
Zip	:	48723-0298
Country	:	US
Telephone Number	:	989-673-4241
Fax Number	:	989-673-4240

Provider Business Practice Location Address
First Line	:	1120 CLEAVER RD
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-1105
Country	:	US
Telephone Number	:	989-673-4241
Fax Number	:	989-673-4240

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MARK OWEN WHITE
Credential	:	DC
Telephone Number	:	989-673-4241

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	04/08/2008

Similar Medicare Providers

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Practice Location Address:

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1366079915 — ROBERT GRENN MD
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1609872464 — ROBERT GABRIEL D.C.
Practice Location Address:

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Directions to “WHITE CHIROPRACTIC HEALTH CARE, PLLC ” Practice Location

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