Provider Demographics
NPI:1205996253
Name:PATRICO, JOSEPH D (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:PATRICO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 24 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3005
Mailing Address - Country:US
Mailing Address - Phone:248-652-0077
Mailing Address - Fax:248-652-0512
Practice Address - Street 1:4501 24 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-3005
Practice Address - Country:US
Practice Address - Phone:248-652-0077
Practice Address - Fax:248-652-0512
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33428Medicare UPIN
MI0F35268Medicare ID - Type Unspecified