Provider Demographics
NPI:1528306743
Name:WHITE, KIMBERLY DIANE (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DIANE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DIANE
Other - Last Name:WOJNAROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:350 N MAIN ST.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1486
Mailing Address - Country:US
Mailing Address - Phone:734-636-0111
Mailing Address - Fax:734-636-0111
Practice Address - Street 1:350 N MAIN ST.
Practice Address - Street 2:SUITE 250
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1486
Practice Address - Country:US
Practice Address - Phone:734-636-0111
Practice Address - Fax:734-636-0111
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor