Provider Demographics
NPI:1336332618
Name:PATTON CHIROPRACTIC SERVICES, INC.
Entity Type:Organization
Organization Name:PATTON CHIROPRACTIC SERVICES, INC.
Other - Org Name:PATTON CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-262-1024
Mailing Address - Street 1:923 EXECUTIVE PARK DR
Mailing Address - Street 2:#C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7263
Mailing Address - Country:US
Mailing Address - Phone:801-262-1024
Mailing Address - Fax:801-262-1286
Practice Address - Street 1:923 EXECUTIVE PARK DR
Practice Address - Street 2:#C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-7263
Practice Address - Country:US
Practice Address - Phone:801-262-1024
Practice Address - Fax:801-262-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT175461-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058069Medicare PIN