Healthcare Provider Details

I. General information

NPI: 1346263050
Provider Name (Legal Business Name): JAMES LESTER BIRD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 MAIN ST
EMMETSBURG IA
50536-1552
US

IV. Provider business mailing address

2301 MAIN ST
EMMETSBURG IA
50536-1552
US

V. Phone/Fax

Practice location:
  • Phone: 712-852-3773
  • Fax: 712-852-3773
Mailing address:
  • Phone: 712-852-3773
  • Fax: 712-852-3773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA06016
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: