Basic Information
Provider Information
NPI: 1780052647
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARQUIS
FirstName: JOSHUA
MiddleName: B
NamePrefix: DR.
NameSuffix:  
Credential: DC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 700688
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782700688
CountryCode: US
TelephoneNumber: 2104777654
FaxNumber: 2104680682
Practice Location
Address1: 301 HIGHLANDER BLVD STE 141
Address2:  
City: ARLINGTON
State: TX
PostalCode: 760181163
CountryCode: US
TelephoneNumber: 8004046050
FaxNumber: 8663133397
Other Information
ProviderEnumerationDate: 09/09/2015
LastUpdateDate: 07/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X13019TXY Chiropractic ProvidersChiropractor 

ID Information
IDTypeStateIssuerDescription
1301901TXTEXAS BOARD OF CHIROPRACTIC EXAMINERSOTHER


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