Provider Demographics
NPI:1669541421
Name:PATRICK, DAVID BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:PATRICK
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 1:505 N. MARKET STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-1516
Mailing Address - Country:US
Mailing Address - Phone:717-361-9130
Mailing Address - Fax:717-689-5243
Practice Address - Street 1:505 N. MARKET STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-1516
Practice Address - Country:US
Practice Address - Phone:717-361-9130
Practice Address - Fax:717-689-5243
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005665-L111N00000X
PADC005665L111N00000X
PAAJ005665L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01891201OtherCAPITAL BLUE CROSS
PA01503292Medicaid
PA01891201OtherCAPITAL BLUE CROSS
PA520665Medicare UPIN