Provider Demographics
NPI:1902804024
Name:WHITE, SUSAN DRAPER (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DRAPER
Last Name:WHITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 C ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7389
Mailing Address - Country:US
Mailing Address - Phone:541-579-0314
Mailing Address - Fax:
Practice Address - Street 1:6803 C ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-7389
Practice Address - Country:US
Practice Address - Phone:541-579-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5776111NS0005X
CO5721111NS0005X
OR3958111NS0005X
MI2301009286111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA134224178OtherTIN
GA134224178OtherTIN
GAU64925Medicare UPIN