Provider Demographics
NPI:1124219084
Name:WEAR, JAMES WILSON (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILSON
Last Name:WEAR
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 1:124 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5074
Mailing Address - Country:US
Mailing Address - Phone:208-466-5459
Mailing Address - Fax:208-466-5803
Practice Address - Street 1:124 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686
Practice Address - Country:US
Practice Address - Phone:208-466-5459
Practice Address - Fax:208-466-5803
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA276111N00000X
IDACC106171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS1067OtherPALMETTO GBA
ID000010008304OtherBLUE SHIELD
IDC3100OtherBLUE CROSS
CS1067OtherPALMETTO GBA