Provider Demographics
NPI:1831359140
Name:JAMES P OTOOLE D C
Entity type:Organization
Organization Name:JAMES P OTOOLE D C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:OTOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-588-9550
Mailing Address - Street 1:23032 ALICIA PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1600
Mailing Address - Country:US
Mailing Address - Phone:949-588-9550
Mailing Address - Fax:949-588-0568
Practice Address - Street 1:23032 ALICIA PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1600
Practice Address - Country:US
Practice Address - Phone:949-588-9550
Practice Address - Fax:949-588-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18571Medicare PIN