Provider Demographics
NPI:1427399393
Name:ST GEORGE WHIPLASH, LLC
Entity Type:Organization
Organization Name:ST GEORGE WHIPLASH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-652-4322
Mailing Address - Street 1:435 N 1680 E STE 6
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1448
Mailing Address - Country:US
Mailing Address - Phone:435-652-4322
Mailing Address - Fax:435-627-2510
Practice Address - Street 1:435 N 1680 E STE 6
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1448
Practice Address - Country:US
Practice Address - Phone:435-652-4322
Practice Address - Fax:435-627-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7655792-1202261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain