Provider Demographics
NPI:1043481500
Name:PATRICK KOLWAITE
Entity type:Organization
Organization Name:PATRICK KOLWAITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOLWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-386-0811
Mailing Address - Street 1:2465 WHITTEN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4722
Mailing Address - Country:US
Mailing Address - Phone:901-386-0811
Mailing Address - Fax:901-386-0812
Practice Address - Street 1:2465 WHITTEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4722
Practice Address - Country:US
Practice Address - Phone:901-386-0811
Practice Address - Fax:901-386-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty