Provider Demographics
NPI:1336153147
Name:DEMETRIOUS, JAMES STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEVEN
Last Name:DEMETRIOUS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4837 CAROLINA BEACH RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2368
Mailing Address - Country:US
Mailing Address - Phone:910-790-8020
Mailing Address - Fax:910-790-8038
Practice Address - Street 1:4837 CAROLINA BEACH RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2368
Practice Address - Country:US
Practice Address - Phone:910-790-8020
Practice Address - Fax:910-790-8038
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890829PMedicaid
NC2452083OtherMEDICARE P TAN NUMBER
NC890829PMedicaid