Provider Demographics
NPI:1568828564
Name:WHITE, MONIQUE G (DC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:G
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 1:1511 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5452
Mailing Address - Country:US
Mailing Address - Phone:573-446-2242
Mailing Address - Fax:573-446-5575
Practice Address - Street 1:1511 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5452
Practice Address - Country:US
Practice Address - Phone:573-446-2242
Practice Address - Fax:573-446-5575
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015044740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor