MEDICARE: DR. JAMES THOMAS TASSELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1492	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4480521	OTHER	OH	UNITED HEALTHCARE ID
2	7521286885	OTHER	OH	ADVANCE PLAN
3	341812722-6A00	OTHER	OH	ANTHEM ID

General Provider Information

NPI Number	:	1518037118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES THOMAS TASSELL

Provider Business Mailing Address
First Line	:	412 E COLUMBUS AVE
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-2004
Country	:	US
Telephone Number	:	937-593-7711
Fax Number	:	937-593-7714

Provider Business Practice Location Address
First Line	:	412 E COLUMBUS AVE
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-2004
Country	:	US
Telephone Number	:	937-593-7711
Fax Number	:	937-593-7714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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