Healthcare Provider Details

I. General information

NPI: 1427399393
Provider Name (Legal Business Name): ST GEORGE WHIPLASH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N 1680 E STE 6
ST GEORGE UT
84790-1448
US

IV. Provider business mailing address

435 N 1680 E STE 6
ST GEORGE UT
84790-1448
US

V. Phone/Fax

Practice location:
  • Phone: 435-652-4322
  • Fax: 435-627-2510
Mailing address:
  • Phone: 435-652-4322
  • Fax: 435-627-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number7655792-1202
License Number StateUT

VIII. Authorized Official

Name: DR. ANDREW PAUL WHITE
Title or Position: OWNER
Credential: DC
Phone: 435-652-4322