Provider Demographics
NPI:1568519726
Name:HASKELL, PATRICK SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:SCOTT
Last Name:HASKELL
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 1:908 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1340
Mailing Address - Country:US
Mailing Address - Phone:618-382-4834
Mailing Address - Fax:618-382-7129
Practice Address - Street 1:908 OAK ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1340
Practice Address - Country:US
Practice Address - Phone:618-384-8341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.008550111N00000X
IL038-008550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008550Medicaid
IL038008550Medicaid
ILL93727Medicare ID - Type Unspecified