=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578638698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES SCOTT LEVAN DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8555 16TH ST SUITE 405
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-2816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-585-5350
-----------------------------------------------------
Fax | 301-585-5369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10945 BUCKNELL DRIVE
-----------------------------------------------------
City | WHEATON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20902-4365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-649-6347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1167
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------