Provider Demographics
NPI:1548988264
Name:LELACHEUR, JOSHUA DAVID (LMT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:LELACHEUR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 FRONT ST NE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3479
Mailing Address - Country:US
Mailing Address - Phone:503-581-1087
Mailing Address - Fax:503-581-1087
Practice Address - Street 1:156 FRONT ST NE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3479
Practice Address - Country:US
Practice Address - Phone:503-581-1087
Practice Address - Fax:503-581-1087
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist