Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2011001547 | MO |
NPI | 1003111956 |
---|---|
Provider Name | Dr. Joshua Middendorf |
First Address | Saint Joseph, MO 64507-1847 |
Second Address | Saint Joseph, MO 64507-1847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2011 |
Last Update Date | 24/01/2011 |