Provider Demographics
NPI:1235238312
Name:DILLMAN, JAMES MATHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATHEW
Last Name:DILLMAN
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 1:2616 EAST MARKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6663
Mailing Address - Country:US
Mailing Address - Phone:765-459-8551
Mailing Address - Fax:765-459-3321
Practice Address - Street 1:2616 EAST MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6663
Practice Address - Country:US
Practice Address - Phone:765-459-8551
Practice Address - Fax:765-459-3321
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001040A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000198378OtherANTHEM BCBS
000000198378OtherANTHEM BCBS
364610Medicare ID - Type Unspecified