Provider Demographics
NPI:1093983645
Name:JARDINE, JAMES M (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:JARDINE
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:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BEND
Mailing Address - State:ID
Mailing Address - Zip Code:83629-0554
Mailing Address - Country:US
Mailing Address - Phone:208-866-8962
Mailing Address - Fax:208-793-4040
Practice Address - Street 1:400 HWY 55
Practice Address - Street 2:
Practice Address - City:HORSESHOE BEND
Practice Address - State:ID
Practice Address - Zip Code:83629-9015
Practice Address - Country:US
Practice Address - Phone:208-866-8962
Practice Address - Fax:208-793-4040
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1234OtherPRACTICE