Provider Demographics
NPI:1912932500
Name:MCDONALD, JAMES B (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:MCDONALD
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 1:100 WILLOW CREEK PKWY
Mailing Address - Street 2:STE C
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4387
Mailing Address - Country:US
Mailing Address - Phone:903-729-5051
Mailing Address - Fax:903-729-0316
Practice Address - Street 1:504 STATE HIGHWAY 110 N STE B
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3040
Practice Address - Country:US
Practice Address - Phone:903-871-9861
Practice Address - Fax:903-871-9863
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601765Medicare ID - Type Unspecified
TXT14710Medicare UPIN