Provider Demographics
NPI:1518054089
Name:GOLDEN, JAMES ROGER (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROGER
Last Name:GOLDEN
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 1:1109 S BELT HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2224
Mailing Address - Country:US
Mailing Address - Phone:816-233-3940
Mailing Address - Fax:816-233-3940
Practice Address - Street 1:1109 S BELT HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2224
Practice Address - Country:US
Practice Address - Phone:816-233-3940
Practice Address - Fax:816-233-3940
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0003418Medicare ID - Type Unspecified