Provider Demographics
NPI:1720399579
Name:PATINO, JOSE A (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:PATINO
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 1:9407 NW 74TH PL
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2312
Mailing Address - Country:US
Mailing Address - Phone:954-825-8490
Mailing Address - Fax:
Practice Address - Street 1:3275 W HILLSBORO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9476
Practice Address - Country:US
Practice Address - Phone:954-825-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor