Provider Demographics
NPI:1265650642
Name:JAMES R. NOLEN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:JAMES R. NOLEN CHIROPRACTIC, INC.
Other - Org Name:CAPITAL VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:NOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-786-0111
Mailing Address - Street 1:729 SUNRISE AVE STE 606
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4542
Mailing Address - Country:US
Mailing Address - Phone:916-786-0111
Mailing Address - Fax:916-786-6410
Practice Address - Street 1:729 SUNRISE AVE STE 606
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4542
Practice Address - Country:US
Practice Address - Phone:916-786-0111
Practice Address - Fax:916-786-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265650642Medicare PIN