Provider Demographics
NPI:1407919764
Name:PATTISON, DONALD D (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:D
Last Name:PATTISON
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 1:3414 W UNION HILLS DR STE 13
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4899
Mailing Address - Country:US
Mailing Address - Phone:623-581-0051
Mailing Address - Fax:623-581-1924
Practice Address - Street 1:3414 W UNION HILLS DR STE 13
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4899
Practice Address - Country:US
Practice Address - Phone:623-581-0051
Practice Address - Fax:623-581-1924
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1407919764OtherNPI INDIVDUAL