Healthcare Provider Details

I. General information

NPI: 1184844474
Provider Name (Legal Business Name): DR. LEROY WHITE D. C. P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 E FILLMORE ST
COLORADO SPRINGS CO
80907-6375
US

IV. Provider business mailing address

824 E FILLMORE ST
COLORADO SPRINGS CO
80907-6375
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-2579
  • Fax: 719-634-2371
Mailing address:
  • Phone: 719-634-2579
  • Fax: 719-634-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1974
License Number StateCO

VIII. Authorized Official

Name: DR. ELVIN LEROY WHITE
Title or Position: OWNER
Credential: D.C.
Phone: 719-634-2579