Provider Demographics
NPI:1952792095
Name:CHILDERS, PATRICIA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ELIZABETH
Other - Last Name:RICHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3316 WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1656
Mailing Address - Country:US
Mailing Address - Phone:903-787-5925
Mailing Address - Fax:903-787-5926
Practice Address - Street 1:3316 WOODS BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-1656
Practice Address - Country:US
Practice Address - Phone:903-787-5925
Practice Address - Fax:903-787-5926
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor