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General NPI Number Information
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NPI Number | 1235682972
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Entity Type | Organization
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Legal Business Name | WHITE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 1100 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8644
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Country | US
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Telephone | 208-375-3500
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Fax | 208-375-3716
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Provider Business Mailing Address
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Address Line | 1100 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8644
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Country | US
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Telephone | 208-375-3500
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Fax | 208-375-3716
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS WHITE
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Credential | DC
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Telephone | 208-375-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHIA-1461
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License Number State | ID
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