Provider Demographics
NPI:1578634291
Name:WHITE, BRANDON C (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:C
Last Name:WHITE
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:3180 RACQUET CLUB DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4797
Mailing Address - Country:US
Mailing Address - Phone:231-933-0069
Mailing Address - Fax:231-933-1566
Practice Address - Street 1:3180 RACQUET CLUB DR
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4797
Practice Address - Country:US
Practice Address - Phone:231-933-0069
Practice Address - Fax:231-933-1566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2301008847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI202489349Medicare UPIN