Provider Demographics
NPI:1013003516
Name:PATZER, PATRICK RAYMOND (DC,PC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RAYMOND
Last Name:PATZER
Suffix:
Gender:M
Credentials:DC,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 FIRST COLONIAL ROAD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3111
Mailing Address - Country:US
Mailing Address - Phone:757-491-2021
Mailing Address - Fax:757-428-2130
Practice Address - Street 1:901 FIRST COLONIAL ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3111
Practice Address - Country:US
Practice Address - Phone:757-491-2021
Practice Address - Fax:757-428-2130
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT21961Medicare UPIN