Provider Demographics
NPI:1881745636
Name:DESHAZO, JAMES DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:DESHAZO
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 1:5461 E MAYFLOWER #6
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-357-6688
Mailing Address - Fax:907-357-9655
Practice Address - Street 1:5461 E MAYFLOWER #6
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-6688
Practice Address - Fax:907-357-9655
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152130Medicare PIN
AKU070753Medicare UPIN