1568412328 NPI number — DR. JAMES NATHANAEL SPRAGUE DC

Table of content: DR. JAMES NATHANAEL SPRAGUE DC (NPI 1568412328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568412328 NPI number — DR. JAMES NATHANAEL SPRAGUE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRAGUE
Provider First Name:
JAMES
Provider Middle Name:
NATHANAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPRAGUE
Provider Other First Name:
JAMES
Provider Other Middle Name:
NATHANAEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1568412328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
328 CLAMDIGGER CRT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-646-5337
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5039 EXECUTIVE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-808-2888
Provider Business Practice Location Address Fax Number:
252-808-3106
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3489 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 9907 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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