Provider Demographics
NPI:1639234479
Name:LOVING, PATRICK J (DC, DICCP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:LOVING
Suffix:
Gender:M
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2567
Mailing Address - Country:US
Mailing Address - Phone:920-432-3311
Mailing Address - Fax:920-432-8010
Practice Address - Street 1:1320 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2567
Practice Address - Country:US
Practice Address - Phone:920-432-3311
Practice Address - Fax:920-432-8010
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2788-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38874800Medicaid
WI70954Medicare ID - Type Unspecified
WI38874800Medicaid