Provider Demographics
NPI:1417167909
Name:FLETCHER, JAMES CAMERON (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CAMERON
Last Name:FLETCHER
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 1:606 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3036
Mailing Address - Country:US
Mailing Address - Phone:253-906-3663
Mailing Address - Fax:
Practice Address - Street 1:606 S STATE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3036
Practice Address - Country:US
Practice Address - Phone:253-906-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0284206OtherL&I PROVIDER ACCOUT NUMBER
WAG8903081OtherMEDICARE PTAN