Provider Demographics
NPI:1639225295
Name:WHITE, COLIN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:JAMES
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 1:1950 KEENE RD
Mailing Address - Street 2:BLDG. P
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7751
Mailing Address - Country:US
Mailing Address - Phone:509-628-1805
Mailing Address - Fax:509-628-1805
Practice Address - Street 1:1950 KEENE RD
Practice Address - Street 2:BLDG. P
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7751
Practice Address - Country:US
Practice Address - Phone:509-628-1805
Practice Address - Fax:509-628-1805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026862Medicaid
WAU89287Medicare UPIN
WA2026862Medicaid