Healthcare Provider Details

I. General information

NPI: 1801991310
Provider Name (Legal Business Name): ADAM LAWRENCE WHITE L.AC., DIPL.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 CAPITOLA RD
CAPITOLA CA
95010-3810
US

IV. Provider business mailing address

4895 CAPITOLA RD
CAPITOLA CA
95010-3810
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-2022
  • Fax: 831-476-7781
Mailing address:
  • Phone: 831-476-2022
  • Fax: 831-476-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: