Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-003465 | IL |
NPI | 1518946391 |
---|---|
Provider Name | Dr. Edwin Paul Patrick |
First Address | Elgin, IL 60123-4703 |
Second Address | Elgin, IL 60123-4756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 05/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L52114 | (02) | IL |