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General NPI Number Information
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NPI Number | 1194975250
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Entity Type | Organization
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Legal Business Name | MARY JO WHITE DCPA
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 606 N SPOKANE ST STE C
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City | POST FALLS
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State | ID
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Zip | 83854-5291
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Country | US
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Telephone | 208-777-2884
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Fax | 208-777-0277
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Provider Business Mailing Address
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Address Line | 606 N SPOKANE ST STE C
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City | POST FALLS
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State | ID
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Zip | 83854-5291
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Country | US
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Telephone | 208-777-2884
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Fax | 208-777-0277
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Authorized Official
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Title or Position | OWNER
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Name | MARY JO WHITE DCPA
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Credential | DC
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Telephone | 208-777-2884
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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 | CHIA713
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License Number State | ID
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