Provider Demographics
NPI:1649274267
Name:WHITE, CHARLES A (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6021
Mailing Address - Country:US
Mailing Address - Phone:803-536-1634
Mailing Address - Fax:803-536-1604
Practice Address - Street 1:235 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6021
Practice Address - Country:US
Practice Address - Phone:803-536-1634
Practice Address - Fax:803-536-1604
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1389Medicaid
SCCH1389Medicaid