Provider Demographics
NPI:1295020410
Name:HANISCH, JOSHUA BLAKE (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:BLAKE
Last Name:HANISCH
Suffix:
Gender:M
Credentials:DC, BS
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Mailing Address - Street 1:4539 DOUGLAS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2711
Mailing Address - Country:US
Mailing Address - Phone:515-276-2263
Mailing Address - Fax:515-251-2969
Practice Address - Street 1:4539 DOUGLAS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2711
Practice Address - Country:US
Practice Address - Phone:515-276-2263
Practice Address - Fax:515-251-2969
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA007433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor