Provider Demographics
NPI:1902039803
Name:MEIDEL, JAMES V
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:MEIDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:V
Other - Last Name:MEIDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 4544
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34948-4544
Mailing Address - Country:US
Mailing Address - Phone:772-871-9402
Mailing Address - Fax:
Practice Address - Street 1:1117 SW DEL RIO BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-1538
Practice Address - Country:US
Practice Address - Phone:772-871-9402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor