Healthcare Provider Details

I. General information

NPI: 1740280742
Provider Name (Legal Business Name): GARY P PATEMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/31/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

205 W MITCHELL ST
PETOSKEY MI
49770-2325
US

IV. Provider business mailing address

101 GREENWOOD CMRTY RD
PETOSKEY MI
49770-8963
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-7272
  • Fax: 231-347-7414
Mailing address:
  • Phone: 231-347-3946
  • Fax: 231-347-1587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberGP008342
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: