Provider Demographics
NPI:1366951360
Name:TAIT, JAMES MELBOURNE IV (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MELBOURNE
Last Name:TAIT
Suffix:IV
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 1:101 N STAFFORD AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4454
Mailing Address - Country:US
Mailing Address - Phone:804-516-0822
Mailing Address - Fax:
Practice Address - Street 1:4911 AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3601
Practice Address - Country:US
Practice Address - Phone:804-254-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor