Provider Demographics
NPI:1114125770
Name:EBBETS, JAMES RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:EBBETS
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 1:300 CAYUGA ST
Mailing Address - Street 2:PO BOX 229
Mailing Address - City:UNION SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13160-0229
Mailing Address - Country:US
Mailing Address - Phone:315-889-3578
Mailing Address - Fax:
Practice Address - Street 1:300 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13160-0229
Practice Address - Country:US
Practice Address - Phone:315-889-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor