Provider Demographics
NPI:1790885861
Name:LINTHICUM, PATRICK JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:LINTHICUM
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 1:939 OFFICE PARK RD 104
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2505
Mailing Address - Country:US
Mailing Address - Phone:515-274-3223
Mailing Address - Fax:515-223-4414
Practice Address - Street 1:939 OFFICE PARK RD 104
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2505
Practice Address - Country:US
Practice Address - Phone:515-274-3223
Practice Address - Fax:515-223-4414
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0072009Medicaid
03947Medicare ID - Type Unspecified
IA0072009Medicaid