Provider Demographics
NPI:1376566885
Name:WHITE, ANDREW J (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
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 1:2019 W. 1900 S.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075
Mailing Address - Country:US
Mailing Address - Phone:801-774-0266
Mailing Address - Fax:
Practice Address - Street 1:2019 W 1900 S
Practice Address - Street 2:SUITE 100
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9579
Practice Address - Country:US
Practice Address - Phone:801-774-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373236-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005783201Medicare ID - Type Unspecified