Provider Demographics
NPI:1588658561
Name:TAXTER, JAMES J (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:TAXTER
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 1:5039 N 19TH AVE
Mailing Address - Street 2:STE 8
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3204
Mailing Address - Country:US
Mailing Address - Phone:602-242-6484
Mailing Address - Fax:602-242-6578
Practice Address - Street 1:5062 N 19TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-242-6484
Practice Address - Fax:602-242-6578
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0939030OtherBLUE CROSS BLUE SHIELD
T02047Medicare UPIN
75240Medicare ID - Type Unspecified