Provider Demographics
NPI:1437138096
Name:STAPLETON, JAMES PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:STAPLETON
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 1:1713 MIDLAND TRL
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1711
Mailing Address - Country:US
Mailing Address - Phone:502-633-1073
Mailing Address - Fax:502-633-4424
Practice Address - Street 1:1713 MIDLAND TRL
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1711
Practice Address - Country:US
Practice Address - Phone:502-633-1073
Practice Address - Fax:502-633-4424
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003036Medicaid
KYU97742Medicare UPIN
KY0947201Medicare ID - Type Unspecified