Healthcare Provider Details

I. General information

NPI: 1124225925
Provider Name (Legal Business Name): JAMES R SPRADLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28525 LOS ANGELES AVE SUITE F
WELLTON AZ
85356-0821
US

IV. Provider business mailing address

PO BOX 821 28525 LOS ANGELES AVE SUITE F
WELLTON AZ
85356-0821
US

V. Phone/Fax

Practice location:
  • Phone: 928-581-2999
  • Fax:
Mailing address:
  • Phone: 928-581-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5080
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number5080
License Number StateAZ

VIII. Authorized Official

Name: JAMES RANDALL SPRADLING
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 928-581-2999