Provider Demographics
NPI:1689765133
Name:WHITE PS, ROGER L (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:L
Last Name:WHITE PS
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 1:417 RAMSAY WAY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4502
Mailing Address - Country:US
Mailing Address - Phone:253-859-0100
Mailing Address - Fax:253-373-9600
Practice Address - Street 1:417 RAMSAY WAY
Practice Address - Street 2:SUITE 113
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4502
Practice Address - Country:US
Practice Address - Phone:253-859-0100
Practice Address - Fax:253-373-9600
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0001238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor