MEDICARE: DR. MARK OWEN WHITE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301300303	MI

General Provider Information

NPI Number	:	1346242633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK OWEN WHITE D.C.

Provider Business Mailing Address
First Line	:	PO BOX 298
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-0298
Country	:	US
Telephone Number	:	989-673-4241
Fax Number	:	989-673-4240

Provider Business Practice Location Address
First Line	:	1120 CLEAVER RD
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-1105
Country	:	US
Telephone Number	:	989-673-4241
Fax Number	:	989-673-4240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/08/2008

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Directions to “ DR. MARK OWEN WHITE D.C.” Practice Location

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