Provider Demographics
NPI:1841273182
Name:WHITE, DALE L JR (DC)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:L
Last Name:WHITE
Suffix:JR
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 1:1141 LONG AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-3012
Mailing Address - Country:US
Mailing Address - Phone:817-625-1165
Mailing Address - Fax:817-740-1701
Practice Address - Street 1:1141 LONG AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-3012
Practice Address - Country:US
Practice Address - Phone:817-625-1165
Practice Address - Fax:817-740-1701
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06009549Medicaid
TX600954Medicare PIN
TX600954Medicare ID - Type Unspecified
TX600954Medicare UPIN
TXUT16580Medicare UPIN