Provider Demographics
NPI:1124098702
Name:COLEMAN, JOHN JAMES JR (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAMES
Last Name:COLEMAN
Suffix:JR
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 1:1857 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5632
Mailing Address - Country:US
Mailing Address - Phone:785-825-5655
Mailing Address - Fax:785-875-5655
Practice Address - Street 1:1857 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5632
Practice Address - Country:US
Practice Address - Phone:785-825-5655
Practice Address - Fax:785-875-5655
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
055870Medicare ID - Type Unspecified