Provider Demographics
NPI:1962419416
Name:HIRSCH, JAMES EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:HIRSCH
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 1:900 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-4236
Mailing Address - Country:US
Mailing Address - Phone:407-322-4155
Mailing Address - Fax:407-322-4151
Practice Address - Street 1:900 W 25TH ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-4236
Practice Address - Country:US
Practice Address - Phone:407-322-4155
Practice Address - Fax:407-322-4151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0002198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380872600Medicaid
FL380872600Medicaid
FL89721Medicare PIN