Provider Demographics
NPI:1053303628
Name:WHITE, MARY E (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206A LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4202
Mailing Address - Country:US
Mailing Address - Phone:512-248-8700
Mailing Address - Fax:512-248-8801
Practice Address - Street 1:206A LAUREL DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4202
Practice Address - Country:US
Practice Address - Phone:512-248-8700
Practice Address - Fax:512-248-8801
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1434227-01Medicaid
TX606255OtherBCBS NUMBER
TX8878OtherSTATE LICENSE NUMBER
TXU84094Medicare UPIN
TX609498Medicare ID - Type Unspecified