Provider Demographics
NPI:1255301859
Name:DRAGONETTE, JOSEPH NICHOLAS (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NICHOLAS
Last Name:DRAGONETTE
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 1:6910 FM 1488 RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-1540
Mailing Address - Country:US
Mailing Address - Phone:281-789-4182
Mailing Address - Fax:281-789-7636
Practice Address - Street 1:6910 FM 1488 RD STE 3
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-1540
Practice Address - Country:US
Practice Address - Phone:281-789-4182
Practice Address - Fax:281-789-7636
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-008917111N00000X
PAAJ-008757111NX0100X
TX14826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA350046982OtherRAILROAD MEDICARE
PADR1330601OtherHIGHMARK BLUE SHIELD
PAU75169Medicare UPIN
PA063026Medicare ID - Type Unspecified