Provider Demographics
NPI:1558449413
Name:MCDONOUGH, PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:MCDONOUGH
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 1:105 PFEFFER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-1934
Mailing Address - Country:US
Mailing Address - Phone:724-325-5500
Mailing Address - Fax:724-733-0419
Practice Address - Street 1:105 PFEFFER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-1934
Practice Address - Country:US
Practice Address - Phone:724-325-5500
Practice Address - Fax:724-733-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007541L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA777688OtherBCBS
PA033875Medicare ID - Type Unspecified
PAU7795Medicare UPIN