MEDICARE: DR. JOSHUA MIDDENDORF D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2011001547	MO

General Provider Information

NPI Number	:	1003111956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA MIDDENDORF D.C.

Provider Business Mailing Address
First Line	:	1512 S 27TH ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64507-1847
Country	:	US
Telephone Number	:	816-232-9437
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 S 27TH ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64507-1847
Country	:	US
Telephone Number	:	816-232-9437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	01/24/2011

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