Provider Demographics
NPI:1891791661
Name:WHITE, STEPHANIE LEIGH (DC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEIGH
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 1:1505 27TH ST
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-2115
Mailing Address - Country:US
Mailing Address - Phone:205-486-5156
Mailing Address - Fax:
Practice Address - Street 1:42431 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7052
Practice Address - Country:US
Practice Address - Phone:205-486-5156
Practice Address - Fax:205-486-7874
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU78638Medicare UPIN