Provider Demographics
NPI:1699811000
Name:WHITE, PRESCOTT JAMES (DC)
Entity Type:Individual
Prefix:MR
First Name:PRESCOTT
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 1:558 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01402
Mailing Address - Country:US
Mailing Address - Phone:978-343-9592
Mailing Address - Fax:978-343-9054
Practice Address - Street 1:558 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5370
Practice Address - Country:US
Practice Address - Phone:978-343-9592
Practice Address - Fax:978-343-9054
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2503513OtherAETNA
MA352484OtherHARVARD PILGRIM
MAY36767OtherBCBS
MA461840OtherSECURE HORIZONS
MA1696874Medicaid
MA21313OtherFALLON
MA1696874Medicaid