Provider Demographics
NPI:1861559403
Name:URQUIA, JOSEPH A (DC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:URQUIA
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 1:1111 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4307
Mailing Address - Country:US
Mailing Address - Phone:360-452-6888
Mailing Address - Fax:360-457-3550
Practice Address - Street 1:1111 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4307
Practice Address - Country:US
Practice Address - Phone:360-452-6888
Practice Address - Fax:360-457-3550
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010742Medicaid
WA83407OtherLABOR
WACH00001282OtherIND LICENSE #
WACH00001282OtherIND LICENSE #