MEDICARE: DR. JAMES A FARMER III 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	2301006934	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950D151500	OTHER	MI	BCBS PROVIDER CODE

General Provider Information

NPI Number	:	1972574754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A FARMER III D.C.

Provider Business Mailing Address
First Line	:	1239 ALPINE AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3170
Country	:	US
Telephone Number	:	616-459-7664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 ALPINE AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3170
Country	:	US
Telephone Number	:	616-459-7664
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	02/23/2009

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