Provider Demographics
NPI:1982626263
Name:NOLL, PATRICK T (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:NOLL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 S SANTA FE AVE
Mailing Address - Street 2:STE F
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6918
Mailing Address - Country:US
Mailing Address - Phone:760-726-1211
Mailing Address - Fax:760-726-3969
Practice Address - Street 1:1011 S SANTA FE AVE
Practice Address - Street 2:STE F
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6918
Practice Address - Country:US
Practice Address - Phone:760-726-1211
Practice Address - Fax:760-726-3969
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA16782111NX0800X
CADC16782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16782Medicare PIN