Provider Demographics
NPI:1992799142
Name:CASANOVA, JAMES MICHEAL (DC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHEAL
Last Name:CASANOVA
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:PO BOX 2016
Mailing Address - Street 2:1102-B SMITH AVE
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-2016
Mailing Address - Country:US
Mailing Address - Phone:229-226-8755
Mailing Address - Fax:229-226-2051
Practice Address - Street 1:1102 SMITH AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5700
Practice Address - Country:US
Practice Address - Phone:229-226-8755
Practice Address - Fax:229-226-2051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2698111N00000X
FL6067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBNLMedicare ID - Type Unspecified
U22697Medicare UPIN