Provider Demographics
NPI:1912098062
Name:NIELAND, JAMES ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROGER
Last Name:NIELAND
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 1:1240 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2625
Mailing Address - Country:US
Mailing Address - Phone:336-838-8842
Mailing Address - Fax:336-838-5387
Practice Address - Street 1:1240 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2625
Practice Address - Country:US
Practice Address - Phone:336-838-8842
Practice Address - Fax:336-838-5387
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085PNMedicaid
NC89085PNMedicaid
NC2457042Medicare ID - Type Unspecified