Provider Demographics
NPI:1669689923
Name:HART, PATRICK LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LYNN
Last Name:HART
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:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OR
Mailing Address - Zip Code:97352-0621
Mailing Address - Country:US
Mailing Address - Phone:541-327-2222
Mailing Address - Fax:
Practice Address - Street 1:277 NORTH SECOND STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OR
Practice Address - Zip Code:97352-0621
Practice Address - Country:US
Practice Address - Phone:541-327-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65 3277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR111804Medicare ID - Type Unspecified