Provider Demographics
NPI:1508876244
Name:WHITE, DEBRA L (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
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 1:1602 E STARR AVE
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4312
Mailing Address - Country:US
Mailing Address - Phone:936-559-1346
Mailing Address - Fax:936-560-0854
Practice Address - Street 1:1602 E STARR AVE
Practice Address - Street 2:201
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4312
Practice Address - Country:US
Practice Address - Phone:936-559-1346
Practice Address - Fax:936-560-0854
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001454001Medicaid
TX001454001Medicaid
TX602070Medicare PIN