Provider Demographics
NPI:1346376944
Name:PRATT, PAUL W (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:PRATT
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 1:3102 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1613
Mailing Address - Country:US
Mailing Address - Phone:520-327-6100
Mailing Address - Fax:520-327-6102
Practice Address - Street 1:3102 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1613
Practice Address - Country:US
Practice Address - Phone:520-327-6100
Practice Address - Fax:520-327-6102
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76370Medicare ID - Type Unspecified