Provider Demographics
NPI:1043361314
Name:CASELLO-MADDOX, PATRICIA MICHELE (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MICHELE
Last Name:CASELLO-MADDOX
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 DREW AVE S APT 209
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2768
Mailing Address - Country:US
Mailing Address - Phone:651-592-7026
Mailing Address - Fax:952-886-7561
Practice Address - Street 1:2501 W 84TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1602
Practice Address - Country:US
Practice Address - Phone:952-888-4777
Practice Address - Fax:952-886-7561
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003669111NX0800X
MN1637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111NX0800XChiropractic ProvidersChiropractorOrthopedic