Provider Demographics
NPI:1346263050
Name:BIRD, JAMES LESTER (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESTER
Last Name:BIRD
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 1:2301 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-1552
Mailing Address - Country:US
Mailing Address - Phone:712-852-3773
Mailing Address - Fax:712-852-3773
Practice Address - Street 1:2301 MAIN ST
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-1552
Practice Address - Country:US
Practice Address - Phone:712-852-3773
Practice Address - Fax:712-852-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1153296Medicaid
IAI1016Medicare ID - Type Unspecified