Provider Demographics
NPI:1740329382
Name:PATTEN CHIROPRACTIC CENTER, PA
Entity type:Organization
Organization Name:PATTEN CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-693-3612
Mailing Address - Street 1:1455 US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-5328
Mailing Address - Country:US
Mailing Address - Phone:320-693-3612
Mailing Address - Fax:320-693-7253
Practice Address - Street 1:1455 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-5328
Practice Address - Country:US
Practice Address - Phone:320-693-3612
Practice Address - Fax:320-693-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN758825900Medicaid
MN47203OtherBCBSM
MN792350106OtherRAILROAD MEDICARE
MN758825900Medicaid