Provider Demographics
NPI:1962043091
Name:WHITE, BALEY M (DC)
Entity Type:Individual
Prefix:
First Name:BALEY
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BALEY
Other - Middle Name:M
Other - Last Name:BERNTHISEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:161 DUE WEST TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-2521
Mailing Address - Country:US
Mailing Address - Phone:419-410-3352
Mailing Address - Fax:
Practice Address - Street 1:76 HIGHLAND PAVILION CT STE 161
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3170
Practice Address - Country:US
Practice Address - Phone:419-410-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty