Provider Demographics
NPI:1588864011
Name:WHITE, WILLIAM BART (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BART
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 1:1120 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1906
Mailing Address - Country:US
Mailing Address - Phone:719-468-2717
Mailing Address - Fax:719-468-2427
Practice Address - Street 1:1120 EAST 3RD ST.
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3324
Practice Address - Country:US
Practice Address - Phone:719-468-2717
Practice Address - Fax:719-468-2427
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor