Healthcare Provider Details

I. General information

NPI: 1982626263
Provider Name (Legal Business Name): PATRICK T NOLL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 S SANTA FE AVE STE F
VISTA CA
92083-6918
US

IV. Provider business mailing address

1011 S SANTA FE AVE STE F
VISTA CA
92083-6918
US

V. Phone/Fax

Practice location:
  • Phone: 760-726-1211
  • Fax: 760-726-3969
Mailing address:
  • Phone: 760-726-1211
  • Fax: 760-726-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number16782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: