Provider Demographics
NPI:1255404638
Name:LESLIE B. WHITE, INC,, PS
Entity type:Organization
Organization Name:LESLIE B. WHITE, INC,, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-246-5370
Mailing Address - Street 1:445 S 152ND ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1107
Mailing Address - Country:US
Mailing Address - Phone:206-246-5370
Mailing Address - Fax:206-246-4806
Practice Address - Street 1:445 S 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1107
Practice Address - Country:US
Practice Address - Phone:206-246-5370
Practice Address - Fax:206-246-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000759111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2964500Medicaid
WA105817Medicare ID - Type Unspecified
WA2964500Medicaid