Provider Demographics
NPI:1063793362
Name:PATRICK CHIROPRACTIC CORP
Entity type:Organization
Organization Name:PATRICK CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-942-7441
Mailing Address - Street 1:205 S EL CAMINO REAL
Mailing Address - Street 2:SUITE G
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4141
Mailing Address - Country:US
Mailing Address - Phone:760-942-7441
Mailing Address - Fax:760-942-7441
Practice Address - Street 1:205 S EL CAMINO REAL
Practice Address - Street 2:SUITE G
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4141
Practice Address - Country:US
Practice Address - Phone:760-942-7441
Practice Address - Fax:760-942-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6581680001OtherPTAN
CADC30164OtherCALIFORNIA
CA6581680001OtherPTAN
6581680001Medicare NSC
CADC30164OtherCALIFORNIA