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General NPI Number Information
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NPI Number | 1891447447
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Entity Type | Individual
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Provider Name | JAY WHITE DC, CCSP, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | N8302 US HIGHWAY 12
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City | ELKHORN
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State | WI
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Zip | 53121-2429
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Country | US
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Telephone | 603-856-6030
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Fax |
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Provider Business Mailing Address
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Address Line | N8302 US HIGHWAY 12
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City | ELKHORN
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State | WI
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Zip | 53121-2429
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Country | US
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Telephone |
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Fax |
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 5701-12
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License Number State | WI
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