MEDICARE: SUSAN DEANNE 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	DC28871	CA

General Provider Information

NPI Number	:	1679506414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DEANNE WHITE D.C

Provider Business Mailing Address
First Line	:	309 LOS ALTOS DR
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-5223
Country	:	US
Telephone Number	:	831-750-9651
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 SOQUEL AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2321
Country	:	US
Telephone Number	:	831-454-9641
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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Directions to “ SUSAN DEANNE WHITE D.C” Practice Location

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