Provider Demographics
NPI:1376733030
Name:PICKETT, JOSHUA D (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:D
Last Name:PICKETT
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 1:1816 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7695
Mailing Address - Country:US
Mailing Address - Phone:850-939-3339
Mailing Address - Fax:850-939-1605
Practice Address - Street 1:1816 ALPINE DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7695
Practice Address - Country:US
Practice Address - Phone:850-939-3339
Practice Address - Fax:850-939-1605
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9374111NR0200X, 111NR0400X, 111NI0013X
FL225700000X
FLCH 9374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001050200Medicaid
FL64346OtherBCBS OF FLORIDA
PICKCHIRO7OtherOPTUM