MEDICARE: DR. JAMES RUSSELL WILEY 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	5709	CO

General Provider Information

NPI Number	:	1376654871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RUSSELL WILEY D.C.

Provider Business Mailing Address
First Line	:	1212 1/2 E US HIGHWAY 24
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-9213
Country	:	US
Telephone Number	:	719-684-7794
Fax Number	:	719-686-9545

Provider Business Practice Location Address
First Line	:	1212 1/2 E US HIGHWAY 24
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-9213
Country	:	US
Telephone Number	:	719-687-6683
Fax Number	:	719-686-9545

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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