Provider Demographics
NPI:1376614453
Name:IABONI, PATRICK (DC, BSC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:IABONI
Suffix:
Gender:M
Credentials:DC, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 WILLAMETTE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4544
Mailing Address - Country:US
Mailing Address - Phone:503-656-1943
Mailing Address - Fax:503-650-5808
Practice Address - Street 1:1609 WILLAMETTE FALLS DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4544
Practice Address - Country:US
Practice Address - Phone:503-656-1943
Practice Address - Fax:503-650-5808
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71-3327111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297980Medicaid