Provider Demographics
NPI:1821163841
Name:REASOR, JOSHUA M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:M
Last Name:REASOR
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 1:2008 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-3126
Mailing Address - Country:US
Mailing Address - Phone:812-254-7227
Mailing Address - Fax:
Practice Address - Street 1:2008 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-3126
Practice Address - Country:US
Practice Address - Phone:812-254-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002101A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN217240Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
INV00552Medicare UPIN