Provider Demographics
NPI:1043385321
Name:WHITE, HARLAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:SCOTT
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 1:821 BRIGHTSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-1100
Mailing Address - Country:US
Mailing Address - Phone:760-788-3734
Mailing Address - Fax:760-788-4401
Practice Address - Street 1:821 BRIGHTSIDE WAY
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-1100
Practice Address - Country:US
Practice Address - Phone:760-788-3734
Practice Address - Fax:760-788-4401
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13422111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17497Medicare UPIN
CADC13422Medicare ID - Type Unspecified