Provider Demographics
NPI:1912951526
Name:VOLLRATH, PATRICK W (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:W
Last Name:VOLLRATH
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 1:855 SPRINGDALE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2852
Mailing Address - Country:US
Mailing Address - Phone:610-561-6100
Mailing Address - Fax:610-524-0133
Practice Address - Street 1:855 SPRINGDALE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2852
Practice Address - Country:US
Practice Address - Phone:610-561-6100
Practice Address - Fax:610-524-0133
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007087L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U05499Medicare UPIN
642274Medicare ID - Type Unspecified
PA021812Medicare PIN