Provider Demographics
NPI:1467541730
Name:VANCE, JAMES L (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:VANCE
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 1:8106 BRODIE LN
Mailing Address - Street 2:# A107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-442-7999
Mailing Address - Fax:512-442-8244
Practice Address - Street 1:8106 BRODIE LN
Practice Address - Street 2:# A107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-442-7999
Practice Address - Fax:512-442-8244
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T16393Medicare UPIN
TX605307Medicare ID - Type Unspecified