Provider Demographics
NPI:1376618140
Name:WHITE, THERESA (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30248 SW THOMAS ST
Mailing Address - Street 2:UNIT 1008
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8653
Mailing Address - Country:US
Mailing Address - Phone:503-537-8559
Mailing Address - Fax:
Practice Address - Street 1:15480 SE 82ND DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9633
Practice Address - Country:US
Practice Address - Phone:503-537-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor