Provider Demographics
NPI:1003938127
Name:SHOTWELL, JAMES ETIENNE JR (CPED)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ETIENNE
Last Name:SHOTWELL
Suffix:JR
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1303
Mailing Address - Country:US
Mailing Address - Phone:517-783-1258
Mailing Address - Fax:517-783-6472
Practice Address - Street 1:103 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1303
Practice Address - Country:US
Practice Address - Phone:517-783-1258
Practice Address - Fax:517-783-6472
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor