Provider Demographics
NPI:1235192238
Name:BISH, JOSEPH TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TODD
Last Name:BISH
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 1:220 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242-1002
Mailing Address - Country:US
Mailing Address - Phone:814-275-4030
Mailing Address - Fax:814-275-4483
Practice Address - Street 1:220 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:16242-1002
Practice Address - Country:US
Practice Address - Phone:814-275-4030
Practice Address - Fax:814-275-4483
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005763L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU56658Medicare UPIN
PA788052Medicare ID - Type Unspecified