Provider Demographics
NPI:1447420013
Name:WHITE, HEATHER KATHLENE (DC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:KATHLENE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:KATHLENE
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:28632 ROADSIDE DRIVE #152
Mailing Address - Street 2:SUITE 152
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301
Mailing Address - Country:US
Mailing Address - Phone:818-616-7953
Mailing Address - Fax:855-873-6138
Practice Address - Street 1:28632 ROADSIDE DR.
Practice Address - Street 2:SUITE #152
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-616-7953
Practice Address - Fax:855-873-6138
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor