Provider Demographics
NPI:1316233802
Name:WHITE CHIROPRACTIC INC.
Entity type:Organization
Organization Name:WHITE CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-793-5226
Mailing Address - Street 1:1150 BROOKSIDE AVE
Mailing Address - Street 2:SUITE J5
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6300
Mailing Address - Country:US
Mailing Address - Phone:909-793-5226
Mailing Address - Fax:909-793-2787
Practice Address - Street 1:1150 BROOKSIDE AVE
Practice Address - Street 2:SUITE J5
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6300
Practice Address - Country:US
Practice Address - Phone:909-793-5226
Practice Address - Fax:909-793-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty