Provider Demographics
NPI:1376634782
Name:WHITE, WILLIAM (NED) EDWARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM (NED)
Middle Name:EDWARD
Last Name:WHITE
Suffix:JR
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 10937
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0115
Mailing Address - Country:US
Mailing Address - Phone:731-660-3880
Mailing Address - Fax:731-660-4377
Practice Address - Street 1:8 STONEBRIDGE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2178
Practice Address - Country:US
Practice Address - Phone:731-660-3880
Practice Address - Fax:731-660-4377
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3111775OtherBC/BS ID
TNU68445Medicare UPIN
TN3111775OtherBC/BS ID