Provider Demographics
NPI:1225305006
Name:WHITE, TRUVAE
Entity Type:Individual
Prefix:DR
First Name:TRUVAE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7931 S DREXEL AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-4177
Mailing Address - Country:US
Mailing Address - Phone:773-941-6900
Mailing Address - Fax:773-941-6912
Practice Address - Street 1:11710 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4732
Practice Address - Country:US
Practice Address - Phone:773-941-6900
Practice Address - Fax:773-941-6912
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor