Provider Demographics
NPI:1922179647
Name:PATTERSON, MARK DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DOUGLAS
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 1:1260 IROQUOIS AVE
Mailing Address - Street 2:SUITE110
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1689
Mailing Address - Country:US
Mailing Address - Phone:630-983-8455
Mailing Address - Fax:630-983-8452
Practice Address - Street 1:1260 IROQUOIS AVE
Practice Address - Street 2:SUITE110
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1689
Practice Address - Country:US
Practice Address - Phone:630-983-8455
Practice Address - Fax:630-983-8452
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL139433250640OtherHUMANA
IL08227869OtherBLUECROSS BLUESHIELD
IL0380094550Medicaid
IL7753355OtherAETNA
IL08227869OtherBLUECROSS BLUESHIELD
IL139433250640OtherHUMANA