Provider Demographics
NPI:1528018306
Name:TALLEY, JAMES WILLIAM JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:TALLEY
Suffix:JR
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 1:411 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-1404
Mailing Address - Country:US
Mailing Address - Phone:580-795-2269
Mailing Address - Fax:580-795-2609
Practice Address - Street 1:411 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-1404
Practice Address - Country:US
Practice Address - Phone:580-795-2269
Practice Address - Fax:580-795-2609
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor