Provider Demographics
NPI:1447364112
Name:FORD, PATRICK MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:MICHAEL
Last Name:FORD
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 1:1905 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-2137
Mailing Address - Country:US
Mailing Address - Phone:504-888-8705
Mailing Address - Fax:504-828-5287
Practice Address - Street 1:2325 SEVERN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-6918
Practice Address - Country:US
Practice Address - Phone:504-828-5285
Practice Address - Fax:504-828-5287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor