Provider Demographics
NPI:1134297617
Name:DOUGHERTY, JAMES RAYMOND JR (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAYMOND
Last Name:DOUGHERTY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2272 DOWNER STREET RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9701
Mailing Address - Country:US
Mailing Address - Phone:315-635-1231
Mailing Address - Fax:315-638-3591
Practice Address - Street 1:2272 DOWNER STREET RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9701
Practice Address - Country:US
Practice Address - Phone:315-635-1231
Practice Address - Fax:315-638-3591
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009094-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB2858Medicare PIN