Provider Demographics
NPI:1740466846
Name:STREET, JAMES FREDERICK (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FREDERICK
Last Name:STREET
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 1:1776 N PINE ISLAND RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5233
Mailing Address - Country:US
Mailing Address - Phone:954-741-5433
Mailing Address - Fax:954-741-7706
Practice Address - Street 1:1776 N PINE ISLAND RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5233
Practice Address - Country:US
Practice Address - Phone:954-741-5433
Practice Address - Fax:954-741-7706
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor