Provider Demographics
NPI:1982629697
Name:PATRICK CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:PATRICK CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-368-2983
Mailing Address - Street 1:415 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-7037
Mailing Address - Country:US
Mailing Address - Phone:352-368-2983
Mailing Address - Fax:352-368-2984
Practice Address - Street 1:415 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7037
Practice Address - Country:US
Practice Address - Phone:352-368-2983
Practice Address - Fax:352-368-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33072OtherBLUE CROSS BLUE SHIELD
FL381393200Medicaid
FL381393200Medicaid