Provider Demographics
NPI:1003294497
Name:DR. MARY NELLE J. DOTSON,, LLC
Entity Type:Organization
Organization Name:DR. MARY NELLE J. DOTSON,, LLC
Other - Org Name:DR. MARY NELLE JAMES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:NELLE JAMES
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-660-0038
Mailing Address - Street 1:625 COMMERCE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2733
Mailing Address - Country:US
Mailing Address - Phone:863-660-0038
Mailing Address - Fax:
Practice Address - Street 1:625 COMMERCE DR STE 102
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2733
Practice Address - Country:US
Practice Address - Phone:863-660-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty