Provider Demographics
NPI:1386733616
Name:PATAVINO, THOMAS M (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:PATAVINO
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 1:60 WATERBURY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1250
Mailing Address - Country:US
Mailing Address - Phone:203-758-7250
Mailing Address - Fax:203-758-7266
Practice Address - Street 1:60 WATERBURY RD
Practice Address - Street 2:SUITE C
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1250
Practice Address - Country:US
Practice Address - Phone:203-758-7250
Practice Address - Fax:203-758-7266
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU97207Medicare UPIN