Provider Demographics
NPI:1932102274
Name:DISPENZA, JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:DISPENZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:DISPENZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-0656
Mailing Address - Country:US
Mailing Address - Phone:360-400-3151
Mailing Address - Fax:360-400-3150
Practice Address - Street 1:503 1ST ST S
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7634
Practice Address - Country:US
Practice Address - Phone:360-400-3151
Practice Address - Fax:360-400-3150
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025202CH00002150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00286072OtherRAILROAD MEDICARE NUMBER
WA330154719OtherFEDERAL CLINC TAX ID
WAP00286072OtherRAILROAD MEDICARE NUMBER
WAGAB39767Medicare ID - Type Unspecified
WAGAB39766Medicare ID - Type UnspecifiedRAINIER CHIRO CLINIC ID#