Provider Demographics
NPI:1356859813
Name:PATCH, DAVID LEE (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:PATCH
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 1:2029 N LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2922
Mailing Address - Country:US
Mailing Address - Phone:563-940-6654
Mailing Address - Fax:
Practice Address - Street 1:3430 TOWNE POINTE DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5320
Practice Address - Country:US
Practice Address - Phone:563-332-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor