Provider Demographics
NPI:1366682759
Name:BADWAY, JOACHIM ELIAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOACHIM
Middle Name:ELIAS
Last Name:BADWAY
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 1:176 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-3829
Mailing Address - Country:US
Mailing Address - Phone:401-275-0812
Mailing Address - Fax:401-275-0819
Practice Address - Street 1:176 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-3829
Practice Address - Country:US
Practice Address - Phone:401-275-0812
Practice Address - Fax:401-275-0819
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor