Provider Demographics
NPI:1952499576
Name:MORT, JAMES RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:MORT
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 724
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:PA
Mailing Address - Zip Code:15665-0724
Mailing Address - Country:US
Mailing Address - Phone:724-863-9982
Mailing Address - Fax:
Practice Address - Street 1:107 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:PA
Practice Address - Zip Code:15665-9721
Practice Address - Country:US
Practice Address - Phone:724-863-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD.C.004661L111NR0400X
WV#543111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2284287OtherAETNA HMO
PAMO480376OtherHGS
PA4355211OtherAETNA PPO
PA4355211OtherAETNA PPO