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General NPI Number Information
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NPI Number | 1871723890
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Entity Type | Individual
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Provider Name | PHILIP IVANOV D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 6935 OLD CANTON RD SUITE A
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City | RIDGELAND
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State | MS
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Zip | 39157-1284
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Country | US
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Telephone | 601-956-6050
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Fax | 601-952-0738
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Provider Business Mailing Address
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Address Line | 6935 OLD CANTON RD SUITE A
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City | RIDGELAND
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State | MS
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Zip | 39157-1284
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Country | US
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Telephone | 601-956-6050
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Fax | 601-952-0738
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1148
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License Number State | MS
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