Healthcare Provider Details

I. General information

NPI: 1114159142
Provider Name (Legal Business Name): JAMES MONROE DIETER III D.C., N.P.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2009
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 CRENSHAW RD SUITE 130
PASADENA TX
77505-3097
US

IV. Provider business mailing address

5010 CRENSHAW RD SUITE 130
PASADENA TX
77505-3097
US

V. Phone/Fax

Practice location:
  • Phone: 281-991-2200
  • Fax: 281-991-7700
Mailing address:
  • Phone: 281-991-2200
  • Fax: 281-991-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number11230
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number776968
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: