Provider Demographics
NPI:1033267141
Name:HUNT, PHILIP REILLY (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:REILLY
Last Name:HUNT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W WESTERN AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-3544
Mailing Address - Country:US
Mailing Address - Phone:574-234-4644
Mailing Address - Fax:574-272-6952
Practice Address - Street 1:2015 W WESTERN AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-3544
Practice Address - Country:US
Practice Address - Phone:574-234-4644
Practice Address - Fax:574-272-6952
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000516A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
728320Medicare ID - Type Unspecified
T35009Medicare UPIN