Provider Demographics
NPI:1396987855
Name:WHITE, LAURA DIANE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DIANE
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:PO BOX 1214
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-1214
Mailing Address - Country:US
Mailing Address - Phone:661-203-8768
Mailing Address - Fax:
Practice Address - Street 1:20041 W VALLEY BLVD
Practice Address - Street 2:#2
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-6746
Practice Address - Country:US
Practice Address - Phone:661-203-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor