Provider Demographics
NPI:1386662500
Name:VANA, JAMES R (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:VANA
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 1:4300 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2511
Mailing Address - Country:US
Mailing Address - Phone:309-764-4753
Mailing Address - Fax:309-764-8753
Practice Address - Street 1:4300 12TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2511
Practice Address - Country:US
Practice Address - Phone:309-764-4753
Practice Address - Fax:309-764-8753
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor