Provider Demographics
NPI:1730228875
Name:PATTERSON, PAUL KENNETH (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENNETH
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3721 KITSAP WAY
Mailing Address - Street 2:STE 8
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2461
Mailing Address - Country:US
Mailing Address - Phone:360-627-9582
Mailing Address - Fax:360-377-3752
Practice Address - Street 1:3721 KITSAP WAY
Practice Address - Street 2:STE 8
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2461
Practice Address - Country:US
Practice Address - Phone:360-627-9582
Practice Address - Fax:360-377-3752
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0005550662OtherAETNA
WA314164OtherLABOR & INDUSTRIES
WA603606OtherOPTUM
WA0005550662OtherAETNA
WA911918090OtherTAX ID NUMBER