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General NPI Number Information
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NPI Number | 1871504688
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Entity Type | Individual
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Provider Name | PATRICK C MACK D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 269 STATE ROUTE 31 S SUITE 5
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City | WASHINGTON
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State | NJ
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Zip | 07882-4086
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Country | US
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Telephone | 908-689-5110
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Fax | 908-689-5409
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Provider Business Mailing Address
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Address Line | 269 STATE ROUTE 31 S SUITE 5
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City | WASHINGTON
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State | NJ
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Zip | 07882-4086
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Country | US
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Telephone | 908-689-5110
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Fax | 908-689-5409
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00565100
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License Number State | NJ
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