Provider Demographics
NPI:1386720332
Name:GATES, JOSHUA EDWARD (DC)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:EDWARD
Last Name:GATES
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 1:1010 W. JASPER RD.
Mailing Address - Street 2:STE. 6
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542
Mailing Address - Country:US
Mailing Address - Phone:254-526-6151
Mailing Address - Fax:254-628-2099
Practice Address - Street 1:1010 W. JASPER RD.
Practice Address - Street 2:STE. 6
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:254-526-6151
Practice Address - Fax:254-628-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1746000Medicaid
TX608127OtherBLUE CROSS BLUE SHIELD
TX608127OtherBLUE CROSS BLUE SHIELD
TX611558Medicare ID - Type Unspecified