Provider Demographics
NPI:1134232275
Name:SPAULDING, JAMES CLARK (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLARK
Last Name:SPAULDING
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 1:106 WATERFORD ST
Mailing Address - Street 2:106 WATERFORD STREET
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-6006
Mailing Address - Country:US
Mailing Address - Phone:814-734-3422
Mailing Address - Fax:814-734-1115
Practice Address - Street 1:106 WATERFORD ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-6006
Practice Address - Country:US
Practice Address - Phone:814-734-3422
Practice Address - Fax:814-734-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 001645 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006196220001Medicaid
11026610OtherCAQH ID
11026610OtherCAQH ID
PA0006196220001Medicaid