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General NPI Number Information
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NPI Number | 1104145531
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Entity Type | Individual
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Provider Name | BRODY RAY WHITE D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 1120 E 3RD ST
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City | LA JUNTA
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State | CO
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Zip | 81050-1906
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Country | US
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Telephone | 719-468-2717
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Fax | 719-468-2427
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Provider Business Mailing Address
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Address Line | 1120 E 3RD ST
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City | LA JUNTA
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State | CO
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Zip | 81050-1906
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Country | US
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Telephone | 719-468-2717
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Fax | 719-468-2427
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6535
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License Number State | CO
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