Provider Demographics
NPI:1407971815
Name:JAMES G. HALVORSON
Entity Type:Organization
Organization Name:JAMES G. HALVORSON
Other - Org Name:HALVORSON CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVORSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-664-1600
Mailing Address - Street 1:997 OLD US HWY 70 W
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2665
Mailing Address - Country:US
Mailing Address - Phone:828-664-1600
Mailing Address - Fax:828-664-1601
Practice Address - Street 1:997 OLD US HWY 70 W
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-2665
Practice Address - Country:US
Practice Address - Phone:828-664-1600
Practice Address - Fax:828-664-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1707111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011R5OtherBCBS GROUP NUMBER
NC89011R5Medicaid
NC2454031Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER