Provider Demographics
NPI:1467565291
Name:WHITE, RODERICK WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:WAYNE
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 1:9050 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9198
Mailing Address - Country:US
Mailing Address - Phone:360-692-2333
Mailing Address - Fax:360-692-2334
Practice Address - Street 1:9050 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9198
Practice Address - Country:US
Practice Address - Phone:360-692-2333
Practice Address - Fax:360-692-2334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor