MEDICARE: DR. DERRILL LOUIS JAMES DC

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	DC9616	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	608164	OTHER	TX	BCBS
2	5691970	OTHER	TX	FIRST HEALTH

General Provider Information

NPI Number	:	1831184308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERRILL LOUIS JAMES DC

Provider Business Mailing Address
First Line	:	5600 S WILLOW DR
Second Line	:	STE 115
City	:	HOUSTON
State	:	TX
Zip	:	77035-4713
Country	:	US
Telephone Number	:	713-726-9111
Fax Number	:	713-726-9112

Provider Business Practice Location Address
First Line	:	5600 S WILLOW DR
Second Line	:	STE 115
City	:	HOUSTON
State	:	TX
Zip	:	77035-4713
Country	:	US
Telephone Number	:	713-726-9111
Fax Number	:	713-726-9112

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	03/07/2008

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Directions to “ DR. DERRILL LOUIS JAMES DC” Practice Location

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