Provider Demographics
NPI:1619985207
Name:WHITE, JEFFREY S (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
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 1:311 N HIGH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6336
Mailing Address - Country:US
Mailing Address - Phone:903-234-2886
Mailing Address - Fax:903-234-2451
Practice Address - Street 1:311 N HIGH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6336
Practice Address - Country:US
Practice Address - Phone:903-234-2886
Practice Address - Fax:903-234-2451
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor