Provider Demographics
NPI:1639394109
Name:PATT, JEFFERY RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:RONALD
Last Name:PATT
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 1:1139 E CEDAR AVE
Mailing Address - Street 2:POB367
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-7003
Mailing Address - Country:US
Mailing Address - Phone:989-426-8461
Mailing Address - Fax:989-426-2121
Practice Address - Street 1:1139 E CEDAR AVE
Practice Address - Street 2:POB367
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-7003
Practice Address - Country:US
Practice Address - Phone:989-426-8461
Practice Address - Fax:989-426-2121
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJP003048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B65003Medicare ID - Type Unspecified