Provider Demographics
NPI:1093880429
Name:DORAIS, JAMES MARTIN (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARTIN
Last Name:DORAIS
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 1:4706 ISABELLA ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8013
Mailing Address - Country:US
Mailing Address - Phone:989-631-9520
Mailing Address - Fax:989-631-1020
Practice Address - Street 1:4706 ISABELLA ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-8013
Practice Address - Country:US
Practice Address - Phone:989-631-9520
Practice Address - Fax:989-631-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E610330OtherBLUE CROSS BLUE SHIELD
MI4103730Medicaid
MION52090Medicare ID - Type Unspecified