Provider Demographics
NPI:1114045853
Name:FAUSEY, JAMES RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:FAUSEY
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 1:170 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3419
Mailing Address - Country:US
Mailing Address - Phone:269-963-8249
Mailing Address - Fax:269-963-0550
Practice Address - Street 1:170 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3419
Practice Address - Country:US
Practice Address - Phone:269-963-8249
Practice Address - Fax:269-963-0550
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A311760OtherBLUE CROSS BLUE SHIELD
MIT32660Medicare UPIN
MIOA350271952Medicare ID - Type Unspecified