Provider Demographics
NPI:1295858868
Name:FERRELL, JOSHUA THEODORE (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:THEODORE
Last Name:FERRELL
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 1:310 E US HIGHWAY 50
Mailing Address - Street 2:STE 2
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 E US HIGHWAY 50
Practice Address - Street 2:STE 2
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2700
Practice Address - Country:US
Practice Address - Phone:618-398-9716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor