Provider Demographics
NPI:1154315406
Name:CHENG, PATRICK C (DC, CCSP, QME)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:C
Last Name:CHENG
Suffix:
Gender:M
Credentials:DC, CCSP, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3532
Mailing Address - Country:US
Mailing Address - Phone:650-737-7667
Mailing Address - Fax:650-737-7996
Practice Address - Street 1:502 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3532
Practice Address - Country:US
Practice Address - Phone:650-737-7667
Practice Address - Fax:650-737-7996
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-01-19
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CADC23636111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU69300Medicare UPIN
CADC0236360Medicare ID - Type Unspecified