Provider Demographics
NPI:1346357647
Name:VANCHO, JAMES EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:VANCHO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:E
Other - Last Name:VANCHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:102 W 11TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9255
Mailing Address - Country:US
Mailing Address - Phone:208-773-1868
Mailing Address - Fax:208-773-6956
Practice Address - Street 1:102 W 11TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9255
Practice Address - Country:US
Practice Address - Phone:208-773-1868
Practice Address - Fax:208-773-6956
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 654111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1672624Medicare ID - Type Unspecified