Provider Demographics
NPI:1700387917
Name:WHITE INTEGRATED HEALTH CLINICS, PLLC
Entity Type:Organization
Organization Name:WHITE INTEGRATED HEALTH CLINICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:817-625-1165
Mailing Address - Street 1:1141 LONG AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-3012
Mailing Address - Country:US
Mailing Address - Phone:817-625-1165
Mailing Address - Fax:817-740-1701
Practice Address - Street 1:1141 LONG AVE
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-3012
Practice Address - Country:US
Practice Address - Phone:817-625-1165
Practice Address - Fax:817-740-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2672111N00000X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty