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General NPI Number Information
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NPI Number | 1942501754
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Entity Type | Individual
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Provider Name | JAMES MATTHEW DREADFULWATER D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 2140 HALL JOHNSON RD STE 115
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City | GRAPEVINE
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State | TX
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Zip | 76051-8754
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Country | US
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Telephone | 817-421-4775
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Fax | 817-421-4303
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Provider Business Mailing Address
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Address Line | 2140 HALL JOHNSON RD STE 115
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City | GRAPEVINE
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State | TX
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Zip | 76051-8754
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Country | US
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Telephone | 817-421-4775
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Fax | 817-421-4303
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11598
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License Number State | TX
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