Provider Demographics
NPI:1902867237
Name:WHITE CHIROPRACTIC
Entity Type:Organization
Organization Name:WHITE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-799-1416
Mailing Address - Street 1:122 GATEWAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5543
Mailing Address - Country:US
Mailing Address - Phone:704-799-1416
Mailing Address - Fax:704-799-1732
Practice Address - Street 1:122 GATEWAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5543
Practice Address - Country:US
Practice Address - Phone:704-799-1416
Practice Address - Fax:704-799-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085JAOtherBCBS
NC89085JAMedicaid
NC89085JAMedicaid
NC=========OtherTIN
NC2455521Medicare ID - Type UnspecifiedGROUP
NC085JAOtherBCBS