Provider Demographics
NPI:1871609917
Name:GOTTFRIED, PATRICK ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ROBERT
Last Name:GOTTFRIED
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 1:5844 CYPRESS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9843
Mailing Address - Country:US
Mailing Address - Phone:812-480-5835
Mailing Address - Fax:
Practice Address - Street 1:8887 HIGH POINTE DR
Practice Address - Street 2:SUITE F
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7969
Practice Address - Country:US
Practice Address - Phone:812-490-7386
Practice Address - Fax:812-490-7386
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007937111N00000X
IN08002502A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL331358OtherHEALTHLINK
IL08021310OtherBCBS OF IL
IL038007937Medicaid
IL038007937Medicaid
IL331358OtherHEALTHLINK