Healthcare Provider Details

I. General information

NPI: 1063418259
Provider Name (Legal Business Name): ROBERT STEVEN PATTERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5567 RESEDA BLVD STE 106
TARZANA CA
91356-2648
US

IV. Provider business mailing address

17322 MARTHA ST
ENCINO CA
91316-1319
US

V. Phone/Fax

Practice location:
  • Phone: 818-349-6060
  • Fax: 818-960-0214
Mailing address:
  • Phone: 818-349-6060
  • Fax: 818-960-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC25167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: