Provider Demographics
NPI:1194745000
Name:PATRICK CHIROPRACTIC SERVICES P.C.
Entity type:Organization
Organization Name:PATRICK CHIROPRACTIC SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-888-3131
Mailing Address - Street 1:750 FLETCHER DR
Mailing Address - Street 2:#304
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4703
Mailing Address - Country:US
Mailing Address - Phone:847-888-3131
Mailing Address - Fax:847-888-3359
Practice Address - Street 1:750 FLETCHER DR
Practice Address - Street 2:#304
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4756
Practice Address - Country:US
Practice Address - Phone:847-888-3131
Practice Address - Fax:847-888-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38003465111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617755OtherBLUE CROSS
IL385670Medicare ID - Type Unspecified
IL1617755OtherBLUE CROSS