Provider Demographics
NPI:1437248275
Name:PATTERSON, ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:PATTERSON
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 1:3702 HURON ST
Mailing Address - Street 2:PO BOX 48
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48461-8142
Mailing Address - Country:US
Mailing Address - Phone:810-688-4891
Mailing Address - Fax:
Practice Address - Street 1:3702 HURON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-8142
Practice Address - Country:US
Practice Address - Phone:810-688-4891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAP008377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D450300OtherBLUE CROSS BLUE SHIELD
MI383594620Medicare UPIN
MI950D450300OtherBLUE CROSS BLUE SHIELD