Provider Demographics
NPI:1487759973
Name:KOTORAC, JAMES P (DC, PC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:KOTORAC
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2533
Mailing Address - Country:US
Mailing Address - Phone:845-268-8886
Mailing Address - Fax:845-268-0277
Practice Address - Street 1:217 ROUTE 303
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2533
Practice Address - Country:US
Practice Address - Phone:845-268-8886
Practice Address - Fax:845-268-0277
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T71243Medicare UPIN
NYX30601Medicare ID - Type Unspecified