Provider Demographics
NPI:1164423372
Name:CAVIEZEL, JAMES G (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:CAVIEZEL
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 1:400 E DIVISION
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-3924
Mailing Address - Country:US
Mailing Address - Phone:360-336-6547
Mailing Address - Fax:360-336-1503
Practice Address - Street 1:400 E DIVISION
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274
Practice Address - Country:US
Practice Address - Phone:360-336-6547
Practice Address - Fax:360-336-1503
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8376923Medicaid
WA11899OtherWA STATE L I
T02932Medicare UPIN
WAG001145201Medicare PIN
WAT02933Medicare UPIN
WA8376923Medicaid