Provider Demographics
NPI:1821336389
Name:PATTERSON, BADEN JAMES (DC)
Entity Type:Individual
Prefix:
First Name:BADEN
Middle Name:JAMES
Last Name:PATTERSON
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 1:3110 MOLEN ST
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-7655
Mailing Address - Country:US
Mailing Address - Phone:208-360-7711
Mailing Address - Fax:208-232-0108
Practice Address - Street 1:3110 MOLEN ST
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-7655
Practice Address - Country:US
Practice Address - Phone:208-360-7711
Practice Address - Fax:208-232-0108
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor