Provider Demographics
NPI:1205993201
Name:VISTITSKY, JOSEPH (DC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:VISTITSKY
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 1:1842 SOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3409
Mailing Address - Country:US
Mailing Address - Phone:850-714-7624
Mailing Address - Fax:
Practice Address - Street 1:7552 NAVARRE PKWY UNIT 5
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7312
Practice Address - Country:US
Practice Address - Phone:850-714-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47-4352086OtherEIN
FL47-4352086OtherEIN
ILT38484Medicare UPIN
IL74880Medicare ID - Type Unspecified