Provider Demographics
NPI:1073693198
Name:BOTHWELL, JAMES WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:BOTHWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 N HALSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1636
Mailing Address - Country:US
Mailing Address - Phone:620-669-8831
Mailing Address - Fax:
Practice Address - Street 1:2300 N PLUM ST STE B
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-8423
Practice Address - Country:US
Practice Address - Phone:620-662-9272
Practice Address - Fax:620-662-0748
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC3649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
060882Medicare ID - Type Unspecified
KST43931Medicare UPIN