Provider Demographics
NPI:1467520312
Name:UPTON, JOSEPH JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:UPTON
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 1:5718 WOODSIDE AVE
Mailing Address - Street 2:SUITE B102
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3444
Mailing Address - Country:US
Mailing Address - Phone:718-651-8410
Mailing Address - Fax:718-651-8568
Practice Address - Street 1:5718 WOODSIDE AVE
Practice Address - Street 2:SUITE B102
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3444
Practice Address - Country:US
Practice Address - Phone:718-651-8410
Practice Address - Fax:718-651-8568
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0052266OtherGHI NO.
NY01898140Medicaid
NYX59611OtherBCBS NO.
NYP424398OtherOXFORD NO.
NYC0-6116-0OtherWORKERS' COMPENSATION NO.
NYX59611OtherBCBS NO.
NYC0-6116-0OtherWORKERS' COMPENSATION NO.