Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 08001617A | IN |
NPI | 1487652277 |
---|---|
Provider Name | Dr. Patrick William Case |
First Address | South Bend, IN 46615-2347 |
Second Address | South Bend, IN 46615-2347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T18539 | (02) | IN |