MEDICARE: WHITE INTEGRATED HEALTH CLINICS, 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	363LF0000X	Family Nurse Practitioner
2	111N00000X	Chiropractor	2672	TX

General Provider Information

NPI Number	:	1700387917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE INTEGRATED HEALTH CLINICS, PLLC

Provider Business Mailing Address
First Line	:	1141 LONG AVE
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-3012
Country	:	US
Telephone Number	:	817-625-1165
Fax Number	:	817-740-1701

Provider Business Practice Location Address
First Line	:	1141 LONG AVE
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-3012
Country	:	US
Telephone Number	:	817-625-1165
Fax Number	:	817-740-1701

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DALE L WHITE JR.
Credential	:	DC
Telephone Number	:	817-625-1165

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	04/30/2019

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