Provider Demographics
NPI:1962776641
Name:MCCREADIE, JOSHUA MILES (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MILES
Last Name:MCCREADIE
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:PO BOX 700688
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0688
Mailing Address - Country:US
Mailing Address - Phone:800-404-6050
Mailing Address - Fax:866-313-3397
Practice Address - Street 1:4900 LIBBLE MILL EAST BLVD
Practice Address - Street 2:SUITE 166
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2131
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:866-313-3397
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557027111NR0400X
VA104557027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104557027OtherCHIROPRACTIC LICENSE