Provider Demographics
NPI:1497894109
Name:WHITE, LEROY WALDO JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:WALDO
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 1:223 WALNUT ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7500
Mailing Address - Country:US
Mailing Address - Phone:508-875-6545
Mailing Address - Fax:508-875-6645
Practice Address - Street 1:223 WALNUT ST
Practice Address - Street 2:SUITE 14
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7500
Practice Address - Country:US
Practice Address - Phone:508-875-6545
Practice Address - Fax:508-875-6645
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA745111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35536Medicare ID - Type UnspecifiedCHIROPRACTIC