Provider Demographics
NPI:1376733030
Name:PICKETT, JOSHUA D (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:D
Last Name:PICKETT
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 1:1816 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7695
Mailing Address - Country:US
Mailing Address - Phone:850-939-3339
Mailing Address - Fax:850-939-1605
Practice Address - Street 1:1816 ALPINE DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7695
Practice Address - Country:US
Practice Address - Phone:850-939-3339
Practice Address - Fax:850-939-1605
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64346OtherBCBS OF FLORIDA
FL001050200Medicaid
FLAH609YMedicare PIN