Provider Demographics
NPI:1538254933
Name:JAMESON, DAVID A (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:JAMESON
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 1:930 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-4104
Mailing Address - Country:US
Mailing Address - Phone:707-263-3124
Mailing Address - Fax:707-263-3125
Practice Address - Street 1:930 11TH STREET
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-4104
Practice Address - Country:US
Practice Address - Phone:707-263-3124
Practice Address - Fax:707-263-3125
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 144090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 14409OtherCA STATE LICENSE D.C.
CAT05362Medicare UPIN
CADC 14409OtherCA STATE LICENSE D.C.