Provider Demographics
NPI:1275553992
Name:WHITE, ROGER W (DC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:W
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 1:325 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-6517
Mailing Address - Country:US
Mailing Address - Phone:615-907-6020
Mailing Address - Fax:615-907-6029
Practice Address - Street 1:325 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-6517
Practice Address - Country:US
Practice Address - Phone:615-907-6020
Practice Address - Fax:615-907-6029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001289111N00000X
VA0104001545111N00000X
GA005611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN56240OtherNATL BD OF CHIRO EXAMINER
TN56240OtherNATL BD OF CHIRO EXAMINER
TN621739733OtherEIN
TN3679638Medicare PIN