Healthcare Provider Details

I. General information

NPI: 1629152962
Provider Name (Legal Business Name): PHILIP DANIEL CONKLIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15055 EAST FWY SUITE C10
CHANNELVIEW TX
77530-4144
US

IV. Provider business mailing address

15055 EAST FWY SUITE C10
CHANNELVIEW TX
77530-4144
US

V. Phone/Fax

Practice location:
  • Phone: 281-862-0800
  • Fax: 281-862-0835
Mailing address:
  • Phone: 281-862-0800
  • Fax: 281-862-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6146
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: