Provider Demographics
NPI:1073803656
Name:IDE, JAMES DEWITT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEWITT
Last Name:IDE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:404 ROUNDS DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1724
Mailing Address - Country:US
Mailing Address - Phone:810-618-6380
Mailing Address - Fax:
Practice Address - Street 1:404 ROUNDS DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1724
Practice Address - Country:US
Practice Address - Phone:317-774-2998
Practice Address - Fax:317-774-3130
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002572A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor