Provider Demographics
NPI:1265047955
Name:TILLOTSON, JOSHUA PAUL (DC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PAUL
Last Name:TILLOTSON
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 1:12100 W 77TH TER APT O
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66216-3360
Mailing Address - Country:US
Mailing Address - Phone:316-323-0405
Mailing Address - Fax:
Practice Address - Street 1:1808 MCGEE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1818
Practice Address - Country:US
Practice Address - Phone:816-471-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor