Provider Demographics
NPI:1063713329
Name:REDD, JOSHUA JAMES (DC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAMES
Last Name:REDD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 N UNIVERSITY PKWY STE 6B
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1584
Mailing Address - Country:US
Mailing Address - Phone:801-235-9955
Mailing Address - Fax:
Practice Address - Street 1:2230 N UNIVERSITY PKWY
Practice Address - Street 2:6B
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1509
Practice Address - Country:US
Practice Address - Phone:801-235-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5791354-1202111NR0400X
UT5791354-7101175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111NR0400XChiropractic ProvidersChiropractorRehabilitation