=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700072881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICK D LAYTON JR DC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2007
-----------------------------------------------------
Last Update Date | 04/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3893 MANNIX DR #517
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34114-5416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-777-5553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 202
-----------------------------------------------------
City | MARCO ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34146-0202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-777-5553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | PATRICK DALE LAYTON JR.
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 239-777-5553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8604
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------