Provider Demographics
NPI:1639201619
Name:WHITE, NOLAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:A
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 1:2050 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1770
Mailing Address - Country:US
Mailing Address - Phone:435-752-1105
Mailing Address - Fax:435-752-5282
Practice Address - Street 1:2050 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1770
Practice Address - Country:US
Practice Address - Phone:435-752-1105
Practice Address - Fax:435-752-5282
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT88-175636-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor