Provider Demographics
NPI:1639104789
Name:PATTERSON, RICHARD D (DC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
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 1:2610 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2724
Mailing Address - Country:US
Mailing Address - Phone:574-271-1771
Mailing Address - Fax:575-271-8014
Practice Address - Street 1:2610 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2724
Practice Address - Country:US
Practice Address - Phone:574-271-1771
Practice Address - Fax:575-271-8014
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002095111N00000X
GACHIRO05965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200465270AMedicaid
IN216760Medicare ID - Type Unspecified
IN200465270AMedicaid