Provider Demographics
NPI:1700872827
Name:BASS, PATRICK J (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:BASS
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 1:335 PARMA DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6507
Mailing Address - Country:US
Mailing Address - Phone:636-386-8233
Mailing Address - Fax:
Practice Address - Street 1:16921 MANCHESTER RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1209
Practice Address - Country:US
Practice Address - Phone:314-958-3858
Practice Address - Fax:636-273-6835
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU95156Medicare UPIN