Provider Demographics
NPI:1346242633
Name:WHITE, MARK OWEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:OWEN
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:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-0298
Mailing Address - Country:US
Mailing Address - Phone:989-673-4241
Mailing Address - Fax:989-673-4240
Practice Address - Street 1:1120 CLEAVER RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1105
Practice Address - Country:US
Practice Address - Phone:989-673-4241
Practice Address - Fax:989-673-4240
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301300303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N84770Medicare ID - Type UnspecifiedGROUP NUMBER
MIU89961Medicare UPIN
MIN84770001Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER