Provider Demographics
NPI:1184477440
Name:DRAKE, JOSH (DC)
Entity type:Individual
Prefix:DR
First Name:JOSH
Middle Name:
Last Name:DRAKE
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 1:23792 ROCKFIELD BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2830
Mailing Address - Country:US
Mailing Address - Phone:949-470-4757
Mailing Address - Fax:
Practice Address - Street 1:23792 ROCKFIELD BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2830
Practice Address - Country:US
Practice Address - Phone:949-470-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor