MEDICARE: DR. JAMES B MCBRIDE 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	2088	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0232990	OTHER	AZ	BC BS AZ PROVIDER NUMBER

General Provider Information

NPI Number	:	1619933751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES B MCBRIDE D.C.

Provider Business Mailing Address
First Line	:	2169 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6833
Country	:	US
Telephone Number	:	928-855-8190
Fax Number	:	928-855-8215

Provider Business Practice Location Address
First Line	:	2169 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6833
Country	:	US
Telephone Number	:	928-855-8190
Fax Number	:	928-855-8215

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	05/08/2012

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