Provider Demographics
NPI:1821076621
Name:FILLA, JAMES MARVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARVIN
Last Name:FILLA
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:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-0647
Mailing Address - Country:US
Mailing Address - Phone:361-387-1716
Mailing Address - Fax:361-387-2599
Practice Address - Street 1:800 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-3135
Practice Address - Country:US
Practice Address - Phone:361-387-1716
Practice Address - Fax:361-387-2599
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU79062Medicare UPIN