Provider Demographics
NPI:1104931823
Name:GIAMMARISE, PATRICK A (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:GIAMMARISE
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 1:2639 FOREST AVE STE 100
Mailing Address - Street 2:STE 100
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2639 FOREST AVE STE 100
Practice Address - Street 2:STE 100
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4393
Practice Address - Country:US
Practice Address - Phone:530-899-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0265490Medicare ID - Type Unspecified