Healthcare Provider Details

I. General information

NPI: 1841200474
Provider Name (Legal Business Name): JEFFREY S WHITE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 HOSPITAL DRIVE
TAPPAHANNOCK VA
22560
US

IV. Provider business mailing address

PO BOX 1830
TAPPAHANNOCK VA
22560-1830
US

V. Phone/Fax

Practice location:
  • Phone: 804-443-6967
  • Fax: 804-443-4938
Mailing address:
  • Phone: 804-443-6967
  • Fax: 804-443-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555570
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: