Provider Demographics
NPI:1245876663
Name:PATRNCHAK, NAOMI AIKO (DC)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:AIKO
Last Name:PATRNCHAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-1819
Mailing Address - Country:US
Mailing Address - Phone:620-257-2040
Mailing Address - Fax:620-257-2038
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-1819
Practice Address - Country:US
Practice Address - Phone:620-257-2040
Practice Address - Fax:620-257-2038
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06029111N00000X
IL038.013473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty