=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629063037
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES RICHARD NEARY DC QME
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2005
-----------------------------------------------------
Last Update Date | 09/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5290 OVERPASS RD STE 101
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93111-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-692-9749
-----------------------------------------------------
Fax | 805-686-2074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 341 BEECH CT
-----------------------------------------------------
City | BUELLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93427-6805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-692-9749
-----------------------------------------------------
Fax | 805-692-1899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 19546
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------