Healthcare Provider Details

I. General information

NPI: 1790343903
Provider Name (Legal Business Name): MICHAEL C WHITE DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14645 NW 77TH AVE STE 107
MIAMI LAKES FL
33014-2569
US

IV. Provider business mailing address

14645 NW 77TH AVE STE 107
MIAMI LAKES FL
33014-2569
US

V. Phone/Fax

Practice location:
  • Phone: 305-570-1965
  • Fax: 305-570-1968
Mailing address:
  • Phone: 305-570-1965
  • Fax: 305-570-1968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL CORWIN WHITE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 561-352-7893