Provider Demographics
NPI:1457491557
Name:JAMES, DET (DC)
Entity Type:Individual
Prefix:DR
First Name:DET
Middle Name:
Last Name:JAMES
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 1:8924 E 96TH STREET
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-9648
Mailing Address - Country:US
Mailing Address - Phone:317-580-1800
Mailing Address - Fax:317-580-9343
Practice Address - Street 1:8924 E 96TH STREET
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-9648
Practice Address - Country:US
Practice Address - Phone:317-580-1800
Practice Address - Fax:317-580-9343
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100130180BMedicaid
IN100130180BMedicaid