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Individual
MR. JAMES D VICTORY
Active
Individual
MR. JAMES D VICTORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
980
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123096
—
MS
05
—
08755862
—
MS
01
—
1866765
FRIST HEALTH PROVIDER #
MS
01
—
64-0931880
TAX ID #
MS
01
—
645632
UNITED HEALTHCARE PROVIDE
MS
01
—
7614197
AETNA PROVIDER #
MS
Enumeration date
10/05/2006
Last updated
08/29/2018
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