Provider Demographics
NPI:1760676001
Name:AUGUSTINE, JAMES L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17150 NORWALK BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2751
Mailing Address - Country:US
Mailing Address - Phone:562-860-3404
Mailing Address - Fax:562-860-3406
Practice Address - Street 1:17150 NORWALK BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2751
Practice Address - Country:US
Practice Address - Phone:562-860-3404
Practice Address - Fax:562-860-3406
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor