Provider Demographics
NPI:1164462149
Name:WHITE, ROBERT DANIEL (DC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
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 1:613 24TH AVE SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3978
Mailing Address - Country:US
Mailing Address - Phone:817-690-6157
Mailing Address - Fax:
Practice Address - Street 1:613 24TH AVE SW
Practice Address - Street 2:SUITE 200
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3978
Practice Address - Country:US
Practice Address - Phone:817-690-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10191111N00000X
OK3826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor