Provider Demographics
NPI:1982717104
Name:MCDONOUGH, PATRICIA A (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2105
Mailing Address - Country:US
Mailing Address - Phone:973-635-2290
Mailing Address - Fax:973-635-8342
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2105
Practice Address - Country:US
Practice Address - Phone:973-635-2290
Practice Address - Fax:973-635-8342
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00145400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121335DHNMedicare ID - Type Unspecified
NJT44731Medicare UPIN