Provider Demographics
NPI:1790343903
Name:MICHAEL C WHITE DC PA
Entity Type:Organization
Organization Name:MICHAEL C WHITE DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CORWIN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-352-7893
Mailing Address - Street 1:14645 NW 77TH AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2569
Mailing Address - Country:US
Mailing Address - Phone:305-570-1965
Mailing Address - Fax:305-570-1968
Practice Address - Street 1:14645 NW 77TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2569
Practice Address - Country:US
Practice Address - Phone:305-570-1965
Practice Address - Fax:305-570-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation