Provider Demographics
NPI:1396898359
Name:OWENS, PATRICK E (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:E
Last Name:OWENS
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 1:52823 W CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-4619
Mailing Address - Country:US
Mailing Address - Phone:574-271-1454
Mailing Address - Fax:574-259-9247
Practice Address - Street 1:913 W MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-5511
Practice Address - Country:US
Practice Address - Phone:574-257-0200
Practice Address - Fax:574-259-9247
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001370A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU37138Medicare UPIN
IN083640Medicare ID - Type Unspecified