Provider Demographics
NPI:1114264991
Name:WHITE, LAURA BUCK (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BUCK
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1638 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-1040
Mailing Address - Country:US
Mailing Address - Phone:314-374-2523
Mailing Address - Fax:
Practice Address - Street 1:4582 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3318
Practice Address - Country:US
Practice Address - Phone:314-892-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013000303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor