Provider Demographics
NPI:1497845374
Name:PHELPS, JAMES MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARTIN
Last Name:PHELPS
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 1:1296 WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4208
Mailing Address - Country:US
Mailing Address - Phone:303-233-5656
Mailing Address - Fax:303-238-0732
Practice Address - Street 1:1296 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4208
Practice Address - Country:US
Practice Address - Phone:303-233-5656
Practice Address - Fax:303-238-0732
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC02585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08025850Medicaid
CO23553Medicare ID - Type Unspecified
CO08025850Medicaid