Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1935 | WI |
NPI | 1003935016 |
---|---|
Provider Name | James T Ford III |
First Address | Stevens Point, WI 54481-5305 |
Second Address | Stevens Point, WI 54481-5305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 05/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
350032388 | RR MEDICARE INDIV # (01) | WI |
38784700 | (05) | WI |
DG2212 | RAILROAD MEDICARE-GRP # (01) | WI |
T61926 | (02) | WI |