Provider Demographics
NPI:1720097751
Name:WALBORN, PATRICK WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WESLEY
Last Name:WALBORN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:WESLEY
Other - Last Name:WALBORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1701 SANTA CLARA DR.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2983
Mailing Address - Country:US
Mailing Address - Phone:916-786-8333
Mailing Address - Fax:916-786-0165
Practice Address - Street 1:1701 SANTA CLARA DR.
Practice Address - Street 2:SUITE 150
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2983
Practice Address - Country:US
Practice Address - Phone:916-786-8333
Practice Address - Fax:916-786-0165
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA012569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor