Provider Demographics
NPI: | 1952602518 |
---|---|
Name: | SCOTT WHITE CHIROPRACTIC LLC |
Entity Type: | Organization |
Organization Name: | SCOTT WHITE CHIROPRACTIC LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SCOTT |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | WHITE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 608-222-2697 |
Mailing Address - Street 1: | 2000 ENGEL ST STE 102 |
Mailing Address - Street 2: | |
Mailing Address - City: | MONONA |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53713-4822 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 608-222-2697 |
Mailing Address - Fax: | 608-222-2719 |
Practice Address - Street 1: | 2000 ENGEL ST STE 102 |
Practice Address - Street 2: | |
Practice Address - City: | MONONA |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53713-4822 |
Practice Address - Country: | US |
Practice Address - Phone: | 608-222-2697 |
Practice Address - Fax: | 608-222-2719 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-11-12 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |