Healthcare Provider Details

I. General information

NPI: 1053511964
Provider Name (Legal Business Name): JAMES DAVID ENYART DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9454 W MAIN ST STE B
BELLEVILLE IL
62223-1729
US

IV. Provider business mailing address

9454 W MAIN ST STE B
BELLEVILLE IL
62223-1729
US

V. Phone/Fax

Practice location:
  • Phone: 618-397-4700
  • Fax: 618-397-4707
Mailing address:
  • Phone: 618-397-4700
  • Fax: 618-397-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number03010976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: