Provider Demographics
NPI:1497852032
Name:SANTIAGO, JAMES JOSEPH (DC, CA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DC, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2721
Mailing Address - Country:US
Mailing Address - Phone:973-344-7777
Mailing Address - Fax:973-344-2223
Practice Address - Street 1:132 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2721
Practice Address - Country:US
Practice Address - Phone:973-344-7777
Practice Address - Fax:973-344-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00248300111NS0005X
NJ25MZ00010100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ503964Medicare PIN