Provider Demographics
NPI:1295895506
Name:MOOTZ, JAMES CLARENCE (D,C,)
Entity type:Individual
Prefix:MISS
First Name:JAMES
Middle Name:CLARENCE
Last Name:MOOTZ
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4221
Mailing Address - Country:US
Mailing Address - Phone:320-235-7506
Mailing Address - Fax:320-235-7506
Practice Address - Street 1:1427 1ST ST S
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4221
Practice Address - Country:US
Practice Address - Phone:320-235-7506
Practice Address - Fax:320-235-7506
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4D032M0OtherBLUECROSS BLUESHIELD INS
MN4D032M0OtherBLUECROSS BLUESHIELD INS