Healthcare Provider Details

I. General information

NPI: 1417024365
Provider Name (Legal Business Name): JOSHUA AMYAS RARDIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 NE HAYES ST
GREENFIELD IA
50849-1048
US

IV. Provider business mailing address

112 NE HAYES ST
GREENFIELD IA
50849-1048
US

V. Phone/Fax

Practice location:
  • Phone: 641-743-2756
  • Fax: 641-343-7308
Mailing address:
  • Phone: 641-743-2756
  • Fax: 641-343-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06922
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011345
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: