Provider Demographics
NPI:1811181647
Name:PATTERSON, MICHAEL RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:PATTERSON
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 1:3317 LINCOLN HWY E
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:PA
Mailing Address - Zip Code:12562-9613
Mailing Address - Country:US
Mailing Address - Phone:717-768-3118
Mailing Address - Fax:
Practice Address - Street 1:3317 LINCOLN HWY E
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:PA
Practice Address - Zip Code:12562-9613
Practice Address - Country:US
Practice Address - Phone:717-768-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 003404 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA465258OtherBLUE SHIELD
PAPA465258Medicare PIN