Provider Demographics
NPI:1508987645
Name:SIEGEL, JAMES BRIAN (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRIAN
Last Name:SIEGEL
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:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:CANYONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97417
Mailing Address - Country:US
Mailing Address - Phone:541-839-4421
Mailing Address - Fax:541-839-6080
Practice Address - Street 1:134 SE 3RD STREET
Practice Address - Street 2:
Practice Address - City:CANYONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97417
Practice Address - Country:US
Practice Address - Phone:541-839-4421
Practice Address - Fax:541-839-6080
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 2790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1841333135OtherCMS
R109231Medicare UPIN
OR8009330614Medicare ID - Type Unspecified