MEDICARE: JOSHUA SPINE AND HEALTH CENTER, PC

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	12472	TX

General Provider Information

NPI Number	:	1558782979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSHUA SPINE AND HEALTH CENTER, PC

Provider Business Mailing Address
First Line	:	332 N BROADWAY ST
Second Line	:
City	:	JOSHUA
State	:	TX
Zip	:	76058-3047
Country	:	US
Telephone Number	:	817-641-1313
Fax Number	:	817-641-1314

Provider Business Practice Location Address
First Line	:	332 N BROADWAY ST
Second Line	:
City	:	JOSHUA
State	:	TX
Zip	:	76058-3047
Country	:	US
Telephone Number	:	817-641-1313
Fax Number	:	817-641-1314

Authorized Official
Title or Position	:	PRESIDENT/CHIROPRACTOR
Name	:	DR. JOSEPH JOHN THOMAS
Credential	:	D.C.
Telephone Number	:	814-571-4996

Provider Enumeration Date	:	01/03/2014
Last Update Date	:	01/03/2014

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