Provider Demographics
NPI:1255083796
Name:SMITH, JOSHUA RYAN (DC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RYAN
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 1:2201 62ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5660
Mailing Address - Country:US
Mailing Address - Phone:727-528-8700
Mailing Address - Fax:727-528-8585
Practice Address - Street 1:2201 62ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5660
Practice Address - Country:US
Practice Address - Phone:727-528-8700
Practice Address - Fax:727-528-8585
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor