Provider Demographics
NPI:1518946391
Name:PATRICK, EDWIN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:PAUL
Last Name:PATRICK
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 1:750 FLETCHER DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4703
Mailing Address - Country:US
Mailing Address - Phone:847-888-3131
Mailing Address - Fax:847-888-3359
Practice Address - Street 1:750 FLETCHER DR
Practice Address - Street 2:SUITE 304
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4756
Practice Address - Country:US
Practice Address - Phone:847-888-3131
Practice Address - Fax:847-888-3359
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003465111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL52114Medicare UPIN
IL385670Medicare ID - Type Unspecified