Provider Demographics
NPI:1134883697
Name:SMITH, JOSHUA GARRETT (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:GARRETT
Last Name:SMITH
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 1:1336 LEAGUE LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3457
Mailing Address - Country:US
Mailing Address - Phone:936-230-5516
Mailing Address - Fax:
Practice Address - Street 1:1336 LEAGUE LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3457
Practice Address - Country:US
Practice Address - Phone:936-230-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor