Provider Demographics
NPI:1992988919
Name:JAMES J. HETHER, D.C., P.L.
Entity type:Organization
Organization Name:JAMES J. HETHER, D.C., P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MANAGING MEMEBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:HETHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-734-0702
Mailing Address - Street 1:2719 S WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7005
Mailing Address - Country:US
Mailing Address - Phone:386-734-0702
Mailing Address - Fax:386-734-6924
Practice Address - Street 1:2719 S WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7005
Practice Address - Country:US
Practice Address - Phone:386-734-0702
Practice Address - Fax:386-734-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU93012Medicare UPIN
FLE8703ZMedicare PIN