=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821336389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BADEN JAMES PATTERSON DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2013
-----------------------------------------------------
Last Update Date | 01/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3110 MOLEN ST
-----------------------------------------------------
City | AMMON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83406-7655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-360-7711
-----------------------------------------------------
Fax | 208-232-0108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3110 MOLEN ST
-----------------------------------------------------
City | AMMON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83406-7655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-360-7711
-----------------------------------------------------
Fax | 208-232-0108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIA-1524
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------