Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5791354-1202 | UT |
NPI | 1063713329 |
---|---|
Provider Name | Joshua James Redd |
First Address | Provo, UT 84604-1584 |
Second Address | Provo, UT 84604-1509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2010 |
Last Update Date | 03/11/2010 |