Provider Demographics
NPI:1669773917
Name:DOTSON, MARY NELLE JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:NELLE JAMES
Last Name:DOTSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:NELLE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 COMMERCE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2733
Mailing Address - Country:US
Mailing Address - Phone:863-660-0038
Mailing Address - Fax:863-582-9343
Practice Address - Street 1:625 COMMERCE DR STE 102
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2733
Practice Address - Country:US
Practice Address - Phone:863-660-0038
Practice Address - Fax:863-582-9343
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor