Provider Demographics
NPI:1568797546
Name:O'DWYER, JAMES M (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:O'DWYER
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 1:11705 E 76TH TER
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2520
Mailing Address - Country:US
Mailing Address - Phone:913-424-7866
Mailing Address - Fax:
Practice Address - Street 1:244 W MILL ST STE 105
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2398
Practice Address - Country:US
Practice Address - Phone:816-368-1318
Practice Address - Fax:816-368-2023
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009035715111N00000X, 111N00000X
OK3958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO230082280Medicaid
MA1268004OtherMEDICARE PTAN