Provider Demographics
NPI:1548212624
Name:HALBERG, JAMES GUSTAF (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GUSTAF
Last Name:HALBERG
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 1:430 E LAURIDSEN BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7978
Mailing Address - Country:US
Mailing Address - Phone:360-457-7576
Mailing Address - Fax:360-452-8079
Practice Address - Street 1:430 E LAURIDSEN BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7978
Practice Address - Country:US
Practice Address - Phone:360-457-7576
Practice Address - Fax:360-452-8079
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0167048OtherLABOR AND INDUSTRIES
WA5327HAOtherREGENCE
WA2027910Medicaid
WAAB36214Medicare ID - Type Unspecified
WA5327HAOtherREGENCE