Provider Demographics
NPI:1962726703
Name:TATE, JOEL A (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:A
Last Name:TATE
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 1:502 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536
Mailing Address - Country:UM
Mailing Address - Phone:850-398-8640
Mailing Address - Fax:850-398-8641
Practice Address - Street 1:502 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4250
Practice Address - Country:US
Practice Address - Phone:850-362-6767
Practice Address - Fax:850-362-6867
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
220COOtherBCBS