Provider Demographics
NPI:1720581838
Name:WHITE, COLTON DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:COLTON
Middle Name:DEAN
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 1:1948 S EAGLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-322-7900
Mailing Address - Fax:208-322-6405
Practice Address - Street 1:1948 S EAGLE ROAD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-322-7900
Practice Address - Fax:208-322-6405
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10724451-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor