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NPI Code Detail

MEDICARE: DR. SUSAN DRAPER WHITE D.C.

MEDICARE: DR. SUSAN DRAPER 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
1111NS0005XSports Physician Chiropractor5776GA
2111NS0005XSports Physician Chiropractor5721CO
3111NS0005XSports Physician Chiropractor3958OR
4111NS0005XSports Physician Chiropractor2301009286MI

General Provider Information

NPI Number : 1902804024
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN DRAPER WHITE D.C.
Provider Business Mailing Address
First Line : 6803 C ST
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97478-7389
Country : US
Telephone Number : 541-579-0314
Fax Number :
Provider Business Practice Location Address
First Line : 6803 C ST
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97478-7389
Country : US
Telephone Number : 541-579-0314
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 09/02/2009

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