Provider Demographics
NPI:1538188545
Name:PATRICK, DONNA ELAINE (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ELAINE
Last Name:PATRICK
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 1:415 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-7037
Mailing Address - Country:US
Mailing Address - Phone:352-368-2983
Mailing Address - Fax:352-368-2984
Practice Address - Street 1:415 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7037
Practice Address - Country:US
Practice Address - Phone:352-368-2983
Practice Address - Fax:352-368-2984
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70606ZOtherBLUE CROSS BLUE SHIELD
FL050739300Medicaid
FL050739300Medicaid