Provider Demographics
NPI:1598899262
Name:WHITE, PHILLIP G (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:G
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 1:8957 S 1300 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9260
Mailing Address - Country:US
Mailing Address - Phone:801-566-5626
Mailing Address - Fax:801-566-0116
Practice Address - Street 1:8957 S 1300 W
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9260
Practice Address - Country:US
Practice Address - Phone:801-566-5626
Practice Address - Fax:801-566-0116
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176233-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU38288Medicare UPIN