=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063943454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN JAMES DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2017
-----------------------------------------------------
Last Update Date | 06/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 JOSHUA LN
-----------------------------------------------------
City | HAWESVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42348-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-927-1000
-----------------------------------------------------
Fax | 270-927-1077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 NE 19TH DR
-----------------------------------------------------
City | OKEECHOBEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34972-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-463-2344
-----------------------------------------------------
Fax | 772-463-9565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH12127
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 280668
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------