Provider Demographics
NPI:1649228677
Name:NILL, JAMES PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:NILL
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 1:4656 W JEFFERSON BLVD
Mailing Address - Street 2:240
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6857
Mailing Address - Country:US
Mailing Address - Phone:260-459-2205
Mailing Address - Fax:260-459-2209
Practice Address - Street 1:4656 W JEFFERSON BLVD
Practice Address - Street 2:240
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6857
Practice Address - Country:US
Practice Address - Phone:260-459-2205
Practice Address - Fax:260-459-2209
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002139A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000322869OtherANTHEM BCBS
IN7694554OtherAETNA
IN000000322869OtherANTHEM BCBS
IN7694554OtherAETNA