MEDICARE: PHILLIP LAVINE CHIROPRACTIC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1316757966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILLIP LAVINE CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	1716 ERRINGER RD STE 100
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-6524
Country	:	US
Telephone Number	:	805-581-8053
Fax Number	:	805-581-8052

Provider Business Practice Location Address
First Line	:	1716 ERRINGER RD STE 100
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-6524
Country	:	US
Telephone Number	:	805-581-8053
Fax Number	:	805-581-8052

Authorized Official
Title or Position	:	OWNER/CEO/PRESIDENT
Name	:	DR. PHILLIP LAVINE
Credential	:	DC
Telephone Number	:	805-581-8053

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	01/07/2025

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