Provider Demographics
NPI:1316267081
Name:ESTRADA, PATRICIA ANGELICA (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANGELICA
Last Name:ESTRADA
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 1:6842 WALDEMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3556
Mailing Address - Country:US
Mailing Address - Phone:314-276-7499
Mailing Address - Fax:
Practice Address - Street 1:23 N GORE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2300
Practice Address - Country:US
Practice Address - Phone:314-276-7499
Practice Address - Fax:314-961-7605
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002017116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5009000009, MA473300OtherMEDICARE PTAN