Provider Demographics
NPI:1417087735
Name:PATRICK, DAWN PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:PATRICK
Last Name:PATRICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 WILLIAMSON ROAD #104
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-664-5433
Mailing Address - Fax:704-664-0825
Practice Address - Street 1:637 WILLIAMSON RD UNIT 104
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8105
Practice Address - Country:US
Practice Address - Phone:704-664-5433
Practice Address - Fax:704-664-0825
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U925220281Medicare UPIN