Provider Demographics
NPI:1508138066
Name:GNEITING, JOSH D (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSH
Middle Name:D
Last Name:GNEITING
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 1:210 W BURNSIDE AVE
Mailing Address - Street 2:STE D
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-4916
Mailing Address - Country:US
Mailing Address - Phone:208-238-5956
Mailing Address - Fax:208-238-5957
Practice Address - Street 1:210 W BURNSIDE AVE
Practice Address - Street 2:STE D
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-4916
Practice Address - Country:US
Practice Address - Phone:208-238-5956
Practice Address - Fax:208-238-5957
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID142100017Medicaid