Provider Demographics
NPI:1396408316
Name:MACKEY, JOSHUA (DR)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MACKEY
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9183 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IA
Mailing Address - Zip Code:52141-9662
Mailing Address - Country:US
Mailing Address - Phone:641-715-4168
Mailing Address - Fax:
Practice Address - Street 1:9183 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IA
Practice Address - Zip Code:52141-9662
Practice Address - Country:US
Practice Address - Phone:641-715-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1092992081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine