Provider Demographics
NPI:1154410462
Name:WISEMAN, JAMES ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 OLD MINDEN RD
Mailing Address - Street 2:SUITE 1203
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2446
Mailing Address - Country:US
Mailing Address - Phone:318-747-5855
Mailing Address - Fax:318-746-0417
Practice Address - Street 1:3018 OLD MINDEN RD
Practice Address - Street 2:SUITE 1203
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2446
Practice Address - Country:US
Practice Address - Phone:318-747-5855
Practice Address - Fax:318-746-0417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T20023Medicare UPIN
59308Medicare ID - Type Unspecified