Provider Demographics
NPI:1851871818
Name:WHITE, SHIQUITA (DC)
Entity Type:Individual
Prefix:
First Name:SHIQUITA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E COMMERCE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2308
Mailing Address - Country:US
Mailing Address - Phone:662-912-9294
Mailing Address - Fax:662-890-0522
Practice Address - Street 1:6942 AUTUMN OAKS DR STE A
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9379
Practice Address - Country:US
Practice Address - Phone:662-890-0012
Practice Address - Fax:662-890-0522
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor