Provider Demographics
NPI:1821151952
Name:DAMROW, JAMES MARK (DC,)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:DAMROW
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 1:3628 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-5837
Mailing Address - Country:US
Mailing Address - Phone:608-754-3696
Mailing Address - Fax:608-754-0782
Practice Address - Street 1:3628 RIDGE DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-5837
Practice Address - Country:US
Practice Address - Phone:608-754-3696
Practice Address - Fax:608-754-0782
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2877-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38908900Medicaid
WIU35509Medicare UPIN
WI38908900Medicaid