Provider Demographics
NPI:1689680340
Name:DISHMAN, JAMES TYLER (DC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TYLER
Last Name:DISHMAN
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 1:606 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747
Mailing Address - Country:US
Mailing Address - Phone:321-939-1010
Mailing Address - Fax:321-900-4563
Practice Address - Street 1:606 FRONT STREET
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747
Practice Address - Country:US
Practice Address - Phone:321-939-1010
Practice Address - Fax:321-900-4563
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4882111N00000X
FLCH9581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor