Provider Demographics
NPI:1134241433
Name:METTLING, JOSHUA SHANE (DC)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:SHANE
Last Name:METTLING
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:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-0623
Mailing Address - Country:US
Mailing Address - Phone:620-221-6325
Mailing Address - Fax:620-221-6327
Practice Address - Street 1:1404 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-4327
Practice Address - Country:US
Practice Address - Phone:620-221-6325
Practice Address - Fax:620-221-6327
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST01102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
660190OtherGROUP PROVIDER #
062428OtherINDIVIDUAL PROVIDER #
1134241433Medicare PIN
062428OtherINDIVIDUAL PROVIDER #