MEDICARE: DR. JAMES ALLEN WISEMAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	422	LA

General Provider Information

NPI Number	:	1154410462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ALLEN WISEMAN D.C.

Provider Business Mailing Address
First Line	:	3018 OLD MINDEN RD
Second Line	:	SUITE 1203
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2446
Country	:	US
Telephone Number	:	318-747-5855
Fax Number	:	318-746-0417

Provider Business Practice Location Address
First Line	:	3018 OLD MINDEN RD
Second Line	:	SUITE 1203
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2446
Country	:	US
Telephone Number	:	318-747-5855
Fax Number	:	318-746-0417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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