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General NPI Number Information
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NPI Number | 1093249914
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Entity Type | Organization
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Legal Business Name | PHILIPS SAN PEDRO CHIROPRACTIC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 505 SOUTH PACIFIC AVENUE SUITE 104
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City | SAN PEDRO
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State | CA
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Zip | 90731-2682
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Country | US
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Telephone | 310-935-2935
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Fax | 310-751-7002
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Provider Business Mailing Address
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Address Line | 505 SOUTH PACIFIC AVENUE SUITE 104
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City | SAN PEDRO
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State | CA
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Zip | 90731-2682
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Country | US
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Telephone | 310-935-2935
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Fax | 310-751-7002
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Authorized Official
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Title or Position | CEO
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Name | DR. RAYMOND JOE PHILIS
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Credential | D.C.
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Telephone | 310-935-2935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 268581
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License Number State | CA
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