Provider Demographics
NPI:1760518468
Name:WHITE, JOHN III (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WHITE
Suffix:III
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 1:122 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MAN
Mailing Address - State:WV
Mailing Address - Zip Code:25635-1229
Mailing Address - Country:US
Mailing Address - Phone:304-583-6335
Mailing Address - Fax:304-583-6800
Practice Address - Street 1:310 MARKET ST
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1321
Practice Address - Country:US
Practice Address - Phone:304-583-6400
Practice Address - Fax:304-583-6800
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7330503OtherAETNA
WV2203080000Medicaid
WV1063653OtherWV COMP
WV7330503OtherAETNA
WV1063653OtherWV COMP