Individual
CLYDE R WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
4411 WALZEM RD, SUITE 108, SAN ANTONIO, TX 78218-2020
(210) 684-3200
(210) 684-3200
Mailing address
325 RIVER SPRINGS DR, SEGUIN, TX 78155-0179
(210) 684-3200
(830) 557-6820
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2154
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00JK40
BLUE CROSS BLUE SHIELD
TX
05
—
D01016701
—
TX
01
—
P00080796
RAILROAD MEDICARE
GA
01
—
P00080796
RAILROAD MEDICARE
TX
Enumeration date
08/22/2006
Last updated
05/07/2008
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