Healthcare Provider Details

I. General information

NPI: 1326054107
Provider Name (Legal Business Name): JAMES STAFFORD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAIN ST N
BOWMAN ND
58623
US

IV. Provider business mailing address

PO BOX 46
BOWMAN ND
58623-0046
US

V. Phone/Fax

Practice location:
  • Phone: 701-400-2288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number676
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: