Provider Demographics
NPI:1194705384
Name:WHITE, ANDREW PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:WHITE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:365 E 20 S
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-5068
Mailing Address - Country:US
Mailing Address - Phone:435-652-4322
Mailing Address - Fax:435-627-2510
Practice Address - Street 1:435 N 1680 E
Practice Address - Street 2:SUITE 6
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8601
Practice Address - Country:US
Practice Address - Phone:435-652-4322
Practice Address - Fax:435-627-2510
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7655792-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12170525OtherCAQH
UT3776795OtherCIGNA
UT107089304101OtherSELECT HEALTH - ASH
UTU000072762Medicare UPIN