Provider Demographics
NPI:1316651128
Name:REBADOW, PATRICK RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RYAN
Last Name:REBADOW
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 1:187 GARDEN VINE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-8047
Mailing Address - Country:US
Mailing Address - Phone:484-529-8200
Mailing Address - Fax:
Practice Address - Street 1:1540 E FRONT ST STE 103
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-6126
Practice Address - Country:US
Practice Address - Phone:919-550-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor