Provider Demographics
NPI:1619933751
Name:MCBRIDE, JAMES B (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:MCBRIDE
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 1:2169 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6833
Mailing Address - Country:US
Mailing Address - Phone:928-855-8190
Mailing Address - Fax:928-855-8215
Practice Address - Street 1:2169 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6833
Practice Address - Country:US
Practice Address - Phone:928-855-8190
Practice Address - Fax:928-855-8215
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0232990OtherBC BS AZ PROVIDER NUMBER
T41925Medicare UPIN