Provider Demographics
NPI:1942501754
Name:DREADFULWATER, JAMES MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:DREADFULWATER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:DREADFULWATER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2140 HALL JOHNSON RD STE 115
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8754
Mailing Address - Country:US
Mailing Address - Phone:817-421-4775
Mailing Address - Fax:817-421-4303
Practice Address - Street 1:2140 HALL JOHNSON RD STE 115
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8754
Practice Address - Country:US
Practice Address - Phone:817-421-4775
Practice Address - Fax:817-421-4303
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor