Provider Demographics
NPI:1386785574
Name:EARLY, JAMES A (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:EARLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1211 RICKMEYER DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-2213
Mailing Address - Country:US
Mailing Address - Phone:920-322-9594
Mailing Address - Fax:920-322-9676
Practice Address - Street 1:1211 RICKMEYER DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-2213
Practice Address - Country:US
Practice Address - Phone:920-322-9594
Practice Address - Fax:920-322-9676
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4006-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI841656122016OtherBCBS
WI38950600Medicaid