Provider Demographics
NPI:1841217346
Name:NOLEN, JAMES RAYMOND
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAYMOND
Last Name:NOLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:PENRYN
Mailing Address - State:CA
Mailing Address - Zip Code:95662
Mailing Address - Country:US
Mailing Address - Phone:916-786-0111
Mailing Address - Fax:916-786-6410
Practice Address - Street 1:729 SUNRISE AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-786-0111
Practice Address - Fax:916-786-6410
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC150030Medicare ID - Type Unspecified
T05595Medicare UPIN