Provider Demographics
NPI:1336548908
Name:PATTERSON, GEORGINA (DC)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:PATTERSON
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 1:4460 REDWOOD HWY
Mailing Address - Street 2:SUITE 16-223
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1951
Mailing Address - Country:US
Mailing Address - Phone:415-342-6794
Mailing Address - Fax:
Practice Address - Street 1:4460 REDWOOD HWY
Practice Address - Street 2:SUITE 16-223
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1951
Practice Address - Country:US
Practice Address - Phone:415-342-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor