Individual ProviderJudson WhiteChiropractorChiropractic ProvidersPractice Address1520 E Heritage Park St Ste 150, Meridian, ID 83646-6837(208) 895-2600PECOS EnrollmentBased on the most recent information from CMS, provider Judson White does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1467998807Provider TypeIndividualFull NameWhite, JudsonTitleDr.CredentialD.C.GenderMaleSole ProprietorYesEnumeration Date1/9/2017Last Updated5/7/2022Contact InformationPractice LocationPractice Address1520 E Heritage Park St Ste 150, Meridian, ID 83646-6837Phone(208) 895-2600Fax(208) 895-2700Mailing LocationMailing Address1520 E Heritage Park St Ste 150, Meridian, ID 83646-6837Phone(208) 895-2600Fax(208) 895-2700Provider TaxonomiesCodeDescriptionLicenseCode111N00000XPrimaryDescriptionChiropractorChiropractic ProvidersLicenseCHIA1741IdahoProvider IdentifiersIDDescriptionIssuerID20012413DescriptionMedicaidIssuerUnlistedIdaho