Provider Demographics
NPI:1750816351
Name:PATCH TECHNIQUE PLLC
Entity Type:Organization
Organization Name:PATCH TECHNIQUE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEGERE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-490-5927
Mailing Address - Street 1:1523 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4302
Mailing Address - Country:US
Mailing Address - Phone:717-490-5927
Mailing Address - Fax:
Practice Address - Street 1:357 S GULPH RD STE 310
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3174
Practice Address - Country:US
Practice Address - Phone:717-490-5927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty