Provider Demographics
NPI:1801991310
Name:WHITE, ADAM LAWRENCE (LAC, DIPLAC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:LAWRENCE
Last Name:WHITE
Suffix:
Gender:M
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 CAPITOLA RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3810
Mailing Address - Country:US
Mailing Address - Phone:831-476-2022
Mailing Address - Fax:831-476-7781
Practice Address - Street 1:4895 CAPITOLA RD
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3810
Practice Address - Country:US
Practice Address - Phone:831-476-2022
Practice Address - Fax:831-476-7781
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4936171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4936OtherACUPUNCTURE LICENSE NUMBE