Provider Demographics
NPI:1114901774
Name:OROURKE, PATRICIA K (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:K
Last Name:OROURKE
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 172
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43447-0172
Mailing Address - Country:US
Mailing Address - Phone:419-693-0719
Mailing Address - Fax:419-693-0710
Practice Address - Street 1:3401 WOODVILLE RD
Practice Address - Street 2:SUITE F
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1529
Practice Address - Country:US
Practice Address - Phone:419-693-0719
Practice Address - Fax:419-693-0710
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128396OtherANTHEM BCBS
OH0240591Medicaid
OH0240591Medicaid
OHOR0406041Medicare ID - Type Unspecified