Provider Demographics
NPI:1467598128
Name:DEKANICH, JOEL T (DC, EMT)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:T
Last Name:DEKANICH
Suffix:
Gender:M
Credentials:DC, EMT
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Mailing Address - Street 1:PO BOX 2637
Mailing Address - Street 2:0105 EDWARDS VILLAGE BL # A203
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-2637
Mailing Address - Country:US
Mailing Address - Phone:970-926-4600
Mailing Address - Fax:970-926-4602
Practice Address - Street 1:105 EDWARDS VILLAGE BLVD
Practice Address - Street 2:SUITE A-203
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-9914
Practice Address - Country:US
Practice Address - Phone:970-926-4600
Practice Address - Fax:970-926-4602
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1637317163W00000X
CO4050111NS0005X
CO0995305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU53509Medicare UPIN
COU53509Medicare UPIN