Provider Demographics
NPI:1174566012
Name:VER VOORT, JAMES G (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:VER VOORT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:N4083 COUNTY RD E
Mailing Address - Street 2:SUITE B
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-7595
Mailing Address - Country:US
Mailing Address - Phone:920-687-2250
Mailing Address - Fax:866-333-2944
Practice Address - Street 1:N4083 COUNTY RD E
Practice Address - Street 2:SUITE B
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-7595
Practice Address - Country:US
Practice Address - Phone:920-687-2250
Practice Address - Fax:866-333-2944
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3564-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU86629Medicare UPIN