# MED SPA AT ENID LIVE WELL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VIKI WHITE
- **Other names:** Enid Live Well
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902437346
- **Legal business name:** VIKI WHITE
- **Authorized official:** DR. VIKI SHARLAIN WHITE DC (CEO)
- **Authorized official phone:** (580) 233-4300

## Contact information

- **Practice address:** 2111 N VAN BUREN ST, ENID, OK 73703-2524
- **Practice address phone:** (580) 233-4300
- **Practice address fax:** (580) 350-6401
- **Mailing address:** 2111 N VAN BUREN ST, ENID, OK 73703-2524
- **Mailing address phone:** (580) 233-4300
- **Mailing address fax:** (580) 350-6401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207ND0900X | Dermatopathology Physician | — | NULL | — |
| 207ND0900X | Dermatopathology Physician | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QP3300X | Pain Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/03/2020
- **Last updated:** 11/11/2020