Healthcare Provider Details

I. General information

NPI: 1558449413
Provider Name (Legal Business Name): PATRICK MCDONOUGH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PFEFFER RD SUITE 5
EXPORT PA
15632-1934
US

IV. Provider business mailing address

105 PFEFFER RD SUITE 5
EXPORT PA
15632-1934
US

V. Phone/Fax

Practice location:
  • Phone: 724-325-5500
  • Fax: 724-733-0419
Mailing address:
  • Phone: 724-325-5500
  • Fax: 724-733-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007541L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier777688
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: