Provider Demographics
NPI:1851341812
Name:HASTERT, PATRICIA (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:HASTERT
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:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-1156
Mailing Address - Country:US
Mailing Address - Phone:530-432-5055
Mailing Address - Fax:530-432-5058
Practice Address - Street 1:17593 PENN VALLEY DR
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-8956
Practice Address - Country:US
Practice Address - Phone:530-432-5055
Practice Address - Fax:530-432-5058
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor