Provider Demographics
NPI:1538413505
Name:CARREIRO, JOSHUA DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DAVID
Last Name:CARREIRO
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 1:1780 S. NOVA ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1777
Mailing Address - Country:US
Mailing Address - Phone:386-788-4778
Mailing Address - Fax:386-788-8110
Practice Address - Street 1:1780 S. NOVA ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1777
Practice Address - Country:US
Practice Address - Phone:386-788-4778
Practice Address - Fax:386-788-8110
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1919655OtherCIGNA
FL860099OtherOPTUM HEALTH
FL220QCOtherBLUE CROSS BLUE SHIELD
GR980ZMedicare PIN