Provider Demographics
NPI:1124225925
Name:JAMES R SPRADLING
Entity Type:Organization
Organization Name:JAMES R SPRADLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:SPRADLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-581-2999
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:28525 LOS ANGELES AVE SUITE F
Mailing Address - City:WELLTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85356-0821
Mailing Address - Country:US
Mailing Address - Phone:928-581-2999
Mailing Address - Fax:
Practice Address - Street 1:28525 LOS ANGELES AVE
Practice Address - Street 2:SUITE F
Practice Address - City:WELLTON
Practice Address - State:AZ
Practice Address - Zip Code:85356-0821
Practice Address - Country:US
Practice Address - Phone:928-581-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5080111N00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ103117Medicare UPIN