Healthcare Provider Details

I. General information

NPI: 1467632877
Provider Name (Legal Business Name): PHILIP DAVID RAKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 MONTROSE AVE
MONTROSE CA
91020-1605
US

IV. Provider business mailing address

2048 MONTROSE AVE
MONTROSE CA
91020-1605
US

V. Phone/Fax

Practice location:
  • Phone: 818-249-8326
  • Fax: 818-352-1105
Mailing address:
  • Phone: 818-249-8326
  • Fax: 818-352-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number15357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: