Provider Demographics
NPI:1801822416
Name:POTERE, JAMES T (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:POTERE
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 1:1099 E BUTLER RD STE 107G
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6539
Mailing Address - Country:US
Mailing Address - Phone:517-902-6677
Mailing Address - Fax:
Practice Address - Street 1:1099 E BUTLER RD STE 107G
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6539
Practice Address - Country:US
Practice Address - Phone:517-902-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008766111N00000X
SC2309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4747916Medicaid
MI4747916Medicaid