Provider Demographics
NPI:1275858573
Name:PLATT, JAMES EDWIN (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWIN
Last Name:PLATT
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:P.O. BOX 579
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445
Mailing Address - Country:US
Mailing Address - Phone:707-884-4008
Mailing Address - Fax:
Practice Address - Street 1:38820 HWY. 1
Practice Address - Street 2:SUITE 108
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445
Practice Address - Country:US
Practice Address - Phone:707-884-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor