Provider Demographics
NPI:1316077936
Name:WHITE, DAVID MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:WHITE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5452
Mailing Address - Country:US
Mailing Address - Phone:573-446-2242
Mailing Address - Fax:573-446-5575
Practice Address - Street 1:1511 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5452
Practice Address - Country:US
Practice Address - Phone:573-446-2242
Practice Address - Fax:573-446-5575
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE5171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42809Medicare UPIN
MO000031121Medicare ID - Type Unspecified