Provider Demographics
NPI:1285723015
Name:KELEHER, JAMES PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:KELEHER
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 1:601 N ROOK AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1630
Mailing Address - Country:US
Mailing Address - Phone:520-745-2002
Mailing Address - Fax:520-745-7846
Practice Address - Street 1:6145 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2505
Practice Address - Country:US
Practice Address - Phone:520-745-1611
Practice Address - Fax:520-745-7846
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4598111NN1001X
AZ171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0234480OtherBLUECROSS/BLUESHIELD
AZWC28100310OtherWORKERSCOMPENSATION
AZWC28100310OtherWORKERSCOMPENSATION