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General NPI Number Information
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NPI Number | 1922236694
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Entity Type | Organization
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Legal Business Name | WHITE CHIROPRACTIC CLINIC PLLC
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 1096 ERIKSON DR
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City | REXBURG
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State | ID
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Zip | 83440-5297
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Country | US
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Telephone | 208-656-3205
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Fax | 208-656-3206
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Provider Business Mailing Address
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Address Line | PO BOX 743
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City | REXBURG
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State | ID
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Zip | 83440-0743
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Country | US
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Telephone | 208-656-3205
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Fax | 208-656-3206
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT WHITE
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Credential | D.C.
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Telephone | 208-656-3205
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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 | CHIA-1111
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License Number State | ID
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