Provider Demographics
NPI:1326178278
Name:SPURLOCK, JAMES MADISON IV (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MADISON
Last Name:SPURLOCK
Suffix:IV
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 1:1318 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3916
Mailing Address - Country:US
Mailing Address - Phone:805-540-2010
Mailing Address - Fax:805-540-2012
Practice Address - Street 1:1318 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3916
Practice Address - Country:US
Practice Address - Phone:805-540-2010
Practice Address - Fax:805-540-2012
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27114ZMedicare ID - Type UnspecifiedCHIROPRACTIC