Provider Demographics
NPI:1184781361
Name:INGALLS, JAMES ARDEN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARDEN
Last Name:INGALLS
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 1:4000 WESLEY ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-9015
Mailing Address - Country:US
Mailing Address - Phone:903-455-5300
Mailing Address - Fax:903-455-5320
Practice Address - Street 1:4000 WESLEY ST STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-9015
Practice Address - Country:US
Practice Address - Phone:903-455-5300
Practice Address - Fax:903-455-5320
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6554OtherSTATE LICENSE NUMBER
TX6554OtherSTATE LICENSE NUMBER
605972Medicare ID - Type Unspecified