Provider Demographics
NPI:1578898839
Name:DEGOOD, JOSHUA NATHANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:NATHANIEL
Last Name:DEGOOD
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 1:2072B E COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2116
Mailing Address - Country:US
Mailing Address - Phone:219-696-6880
Mailing Address - Fax:
Practice Address - Street 1:2072B E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2116
Practice Address - Country:US
Practice Address - Phone:219-696-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002435A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor