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General NPI Number Information
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NPI Number | 1114326717
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Entity Type | Individual
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Provider Name | DONALD LESLIE WHITE D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 1141 LONG AVE
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City | RIVER OAKS
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State | TX
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Zip | 76114-3012
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Country | US
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Telephone | 817-625-1165
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Fax | 817-740-1701
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Provider Business Mailing Address
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Address Line | 1411 LONG AVE
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City | FORT WORTH
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State | TX
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Zip | 76114
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Country | US
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Telephone | 817-625-1165
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Fax | 817-740-1701
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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 | 12721
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License Number State | TX
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