Provider Demographics
NPI:1366488819
Name:KIESER, JAMES R II (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:KIESER
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5634 HIGHWAY 78
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-3773
Mailing Address - Country:US
Mailing Address - Phone:972-496-4200
Mailing Address - Fax:972-496-4400
Practice Address - Street 1:5634 HIGHWAY 78
Practice Address - Street 2:SUITE 120
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-3773
Practice Address - Country:US
Practice Address - Phone:972-496-4200
Practice Address - Fax:972-496-4400
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8576111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7641OtherBCBS INDIVIDUAL ID#
TX8A7641OtherBCBS INDIVIDUAL ID#
TX8A6559Medicare PIN