Provider Demographics
NPI:1568532265
Name:WOMELDUFF, JAMES CHANDLER IV (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHANDLER
Last Name:WOMELDUFF
Suffix:IV
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 636
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-0636
Mailing Address - Country:US
Mailing Address - Phone:816-297-6878
Mailing Address - Fax:
Practice Address - Street 1:33 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MO
Practice Address - Zip Code:64720
Practice Address - Country:US
Practice Address - Phone:816-297-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25445012OtherBCBS KANSAS CITY
MO000A869AMedicare UPIN