Provider Demographics
NPI:1831160126
Name:MCDERMOTT, JAMES ROBERT (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:MCDERMOTT
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 1:700 S POTOMAC ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2198
Mailing Address - Country:US
Mailing Address - Phone:717-762-1773
Mailing Address - Fax:717-762-8544
Practice Address - Street 1:569 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5731
Practice Address - Country:US
Practice Address - Phone:570-288-5800
Practice Address - Fax:570-288-5900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ-007572-L111NX0100X
PADC-007572-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Not Answered111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00115858OtherRAILROAD MEDICARE
PAMC348462OtherHIGHMARK BLUE SHIELD
PAP00115858OtherRAILROAD MEDICARE
PAU79199Medicare UPIN