Provider Demographics
NPI:1750654299
Name:CRISS, PATRICK J (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:CRISS
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 1:1750 DONALD DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1921
Mailing Address - Country:US
Mailing Address - Phone:813-526-4287
Mailing Address - Fax:
Practice Address - Street 1:4343 SHALLOWFORD RD STE 160
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5075
Practice Address - Country:US
Practice Address - Phone:813-526-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2023-10-18
Deactivation Date:2013-06-13
Deactivation Code:
Reactivation Date:2015-10-30
Provider Licenses
StateLicense IDTaxonomies
FLCH10295111N00000X
GACHIR009545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor