Provider Demographics
NPI:1699789099
Name:CHILDERS, JAMES ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:CHILDERS
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 1:2333 S 291 HWY
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1201
Mailing Address - Country:US
Mailing Address - Phone:816-478-0810
Mailing Address - Fax:816-478-0811
Practice Address - Street 1:2333 S 291 HWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1201
Practice Address - Country:US
Practice Address - Phone:816-478-0810
Practice Address - Fax:816-478-0811
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0007483Medicare ID - Type Unspecified
KS0007483Medicare ID - Type Unspecified
U52854Medicare UPIN
MO0007483Medicare ID - Type Unspecified