Provider Demographics
NPI:1114326717
Name:WHITE, DONALD LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LESLIE
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 1:1411 LONG AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114
Mailing Address - Country:US
Mailing Address - Phone:817-625-1165
Mailing Address - Fax:817-740-1701
Practice Address - Street 1:1141 LONG AVE
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-3012
Practice Address - Country:US
Practice Address - Phone:817-625-1165
Practice Address - Fax:817-740-1701
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor