Provider Demographics
NPI:1396715405
Name:JOSEPH, JOHN ARTHUR (DC, PC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ARTHUR
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S LOGAN BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-943-3033
Mailing Address - Fax:814-943-1210
Practice Address - Street 1:411 S LOGAN BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4101
Practice Address - Country:US
Practice Address - Phone:814-943-3033
Practice Address - Fax:814-943-1210
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 002521 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009138120001Medicaid
PAJO197017Medicare ID - Type Unspecified
PA0009138120001Medicaid