Provider Demographics
NPI:1548562762
Name:WHITE, MICAH RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:RYAN
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 1:1150 BROOKSIDE AVE
Mailing Address - Street 2:SUITE J5
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6303
Mailing Address - Country:US
Mailing Address - Phone:909-793-5226
Mailing Address - Fax:909-793-2787
Practice Address - Street 1:1150 BROOKSIDE AVE
Practice Address - Street 2:SUITE J5
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6303
Practice Address - Country:US
Practice Address - Phone:909-793-5226
Practice Address - Fax:909-793-2787
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor