Healthcare Provider Details

I. General information

NPI: 1972541977
Provider Name (Legal Business Name): PHILIP N CILLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODLANE DR
BLACKWOOD NJ
08012-4507
US

IV. Provider business mailing address

10 WOODLANE DR
BLACKWOOD NJ
08012-4507
US

V. Phone/Fax

Practice location:
  • Phone: 856-228-0019
  • Fax: 856-228-7992
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00495200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: