Provider Demographics
NPI:1700818325
Name:MAHAN, PATRICK LEROY (D C)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LEROY
Last Name:MAHAN
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5923
Mailing Address - Country:US
Mailing Address - Phone:325-655-1070
Mailing Address - Fax:325-655-1036
Practice Address - Street 1:302 E BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5923
Practice Address - Country:US
Practice Address - Phone:325-655-1070
Practice Address - Fax:325-655-1036
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 2748111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350043251OtherRAILROAD MEDICARE
TX601089OtherBLUE CROSS BLUE SHIELD
TXT14554Medicare UPIN
TX601089OtherBLUE CROSS BLUE SHIELD