Provider Demographics
NPI:1194234336
Name:PATTERSON, JOLENE D (DC)
Entity type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:D
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LAKE DAVENPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-9405
Mailing Address - Country:US
Mailing Address - Phone:863-256-5030
Mailing Address - Fax:
Practice Address - Street 1:4273 NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6744
Practice Address - Country:US
Practice Address - Phone:248-701-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor