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General NPI Number Information
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NPI Number | 1780650424
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Entity Type | Individual
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Provider Name | SCOTT ALAN WHITE ATC
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7500 W MONTROSE AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-1153
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Country | US
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Telephone | 708-456-4242
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Fax | 708-456-1573
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Provider Business Mailing Address
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Address Line | 1639 N NARRAGANSETT AVE
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City | CHICAGO
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State | IL
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Zip | 60639-3823
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Country | US
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Telephone | 708-516-3761
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Fax | 708-456-1573
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096-0000137
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License Number State | IL
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