Provider Demographics
NPI:1710191531
Name:PATRICK E CHASE DC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PATRICK E CHASE DC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-774-0091
Mailing Address - Street 1:29050 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1200
Mailing Address - Country:US
Mailing Address - Phone:586-774-0091
Mailing Address - Fax:
Practice Address - Street 1:29050 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1200
Practice Address - Country:US
Practice Address - Phone:586-774-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPC004238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA611658500OtherFEDERAL WORKMAN'S COMP.
MI=========OtherCOMMERICAL INSURANCE
MI=========OtherCOMMERICAL INSURANCE
MI0E06384Medicare ID - Type UnspecifiedMEDICARE & BLUE CROSS