Provider Demographics
NPI:1871504688
Name:MACK, PATRICK C (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:C
Last Name:MACK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:269 STATE ROUTE 31 S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4086
Mailing Address - Country:US
Mailing Address - Phone:908-689-5110
Mailing Address - Fax:908-689-5409
Practice Address - Street 1:269 STATE ROUTE 31 S
Practice Address - Street 2:SUITE 5
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4086
Practice Address - Country:US
Practice Address - Phone:908-689-5110
Practice Address - Fax:908-689-5409
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00565100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor