Provider Demographics
NPI:1205843190
Name:DAUTEL, JAMES WALTER (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WALTER
Last Name:DAUTEL
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 1:784 BLANDING BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:904-272-4555
Mailing Address - Fax:904-276-2521
Practice Address - Street 1:784 BLANDING BLVD
Practice Address - Street 2:ORANGE PARK CHIROPRACTIC
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:904-272-4555
Practice Address - Fax:904-276-2521
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U21558Medicare UPIN
FL88922Medicare ID - Type Unspecified