Provider Demographics
NPI:1871685941
Name:PATT, JAY ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ROBERT
Last Name:PATT
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 1:123 MARGARET LANE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-477-6252
Mailing Address - Fax:530-477-1360
Practice Address - Street 1:123 MARGARET LANE
Practice Address - Street 2:SUITE A2
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-477-6252
Practice Address - Fax:530-477-1360
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T17639Medicare UPIN
CADC0139160Medicare ID - Type Unspecified