Provider Demographics
NPI:1518037118
Name:TASSELL, JAMES THOMAS
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:TASSELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2004
Mailing Address - Country:US
Mailing Address - Phone:937-593-7711
Mailing Address - Fax:937-593-7714
Practice Address - Street 1:412 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2004
Practice Address - Country:US
Practice Address - Phone:937-593-7711
Practice Address - Fax:937-593-7714
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4480521OtherUNITED HEALTHCARE ID
OH7521286885OtherADVANCE PLAN
OH341812722-6A00OtherANTHEM ID
OH7521286885OtherADVANCE PLAN