Provider Demographics
NPI:1164750592
Name:DISHMAN, JAMES DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DONALD
Last Name:DISHMAN
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 1:3516 CARDINAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-4683
Mailing Address - Country:US
Mailing Address - Phone:386-212-6014
Mailing Address - Fax:
Practice Address - Street 1:3516 CARDINAL BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-4683
Practice Address - Country:US
Practice Address - Phone:386-212-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5473111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology