Provider Demographics
NPI:1699807891
Name:PATTERSON, LARRY DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DOUGLAS
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 1:272 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-6622
Mailing Address - Country:US
Mailing Address - Phone:423-836-1412
Mailing Address - Fax:
Practice Address - Street 1:463 1ST ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1760
Practice Address - Country:US
Practice Address - Phone:423-479-9487
Practice Address - Fax:423-472-8570
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT-74602Medicare UPIN