Provider Demographics
NPI:1417966318
Name:WAIKEM, PATRICK B (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:B
Last Name:WAIKEM
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 1:1430 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5909
Mailing Address - Country:US
Mailing Address - Phone:210-733-9999
Mailing Address - Fax:210-735-5233
Practice Address - Street 1:1430 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5909
Practice Address - Country:US
Practice Address - Phone:210-733-9999
Practice Address - Fax:210-735-5233
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor