Provider Demographics
NPI:1407942337
Name:PATTEN, ROGER EARL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:EARL
Last Name:PATTEN
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 1:1455 US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-5328
Mailing Address - Country:US
Mailing Address - Phone:320-693-3612
Mailing Address - Fax:320-693-7253
Practice Address - Street 1:1455 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-5328
Practice Address - Country:US
Practice Address - Phone:320-693-3612
Practice Address - Fax:320-693-7253
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN758825900Medicaid
MN792350106OtherRAILROAD MEDICARE
MN030701065Medicaid
MN47203PAOtherBCBSM
MN030701065Medicaid