Organization
WHITE CHIROPRACTIC CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT WHITE D.C. (OWNER)
(208) 656-3205
Entity
Organization
Contact information
Practice address
1096 ERIKSON DR, REXBURG, ID 83440-5297
(208) 656-3205
(208) 656-3206
Mailing address
PO BOX 743, REXBURG, ID 83440-0743
(208) 656-3205
(208) 656-3206
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1111
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149474
BLUE SHIELD
ID
05
—
807090700
—
ID
01
—
C4439
BLUE CROSS
ID
Enumeration date
07/01/2009
Last updated
07/01/2009
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