MEDICARE: DR. PHILIP DAVID EDDY D.C.

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	111NX0800X	Orthopedic Chiropractor	17436	CA

General Provider Information

NPI Number	:	1891794749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP DAVID EDDY D.C.

Provider Business Mailing Address
First Line	:	19038 SOLEDAD CANYON RD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3362
Country	:	US
Telephone Number	:	661-252-5192
Fax Number	:

Provider Business Practice Location Address
First Line	:	19038 SOLEDAD CANYON RD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3362
Country	:	US
Telephone Number	:	661-252-5192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/14/2012

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