Provider Demographics
NPI:1932189925
Name:KOLWAITE, PATRICK A (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:KOLWAITE
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 1:2465 WHITTEN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4722
Mailing Address - Country:US
Mailing Address - Phone:901-386-0811
Mailing Address - Fax:901-386-0812
Practice Address - Street 1:2465 WHITTEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4722
Practice Address - Country:US
Practice Address - Phone:901-386-0811
Practice Address - Fax:901-386-0812
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRR MEDICAREOtherRR MEDICARE
TNU91606OtherHEALTHSPRINGS
TN4036773OtherBCBS
TN39 72669Medicare ID - Type Unspecified
TNU91606Medicare UPIN