Healthcare Provider Details

I. General information

NPI: 1518802677
Provider Name (Legal Business Name): DALLIN WHITE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 OLD 28TH ST SE
GRAND RAPIDS MI
49546-6932
US

IV. Provider business mailing address

1102 CEDARWOOD DR
GREENVILLE MI
48838-2646
US

V. Phone/Fax

Practice location:
  • Phone: 334-470-1266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017340
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: