Provider Demographics
NPI:1568552743
Name:WHITE, PHILIP BRUCE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BRUCE
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 1:1204 SMALLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3264
Mailing Address - Country:US
Mailing Address - Phone:270-782-5400
Mailing Address - Fax:270-782-5545
Practice Address - Street 1:1204 SMALLHOUSE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3264
Practice Address - Country:US
Practice Address - Phone:270-782-5400
Practice Address - Fax:270-782-5545
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6098301Medicare ID - Type Unspecified