Provider Demographics
NPI:1073568432
Name:MOLLICA, PHILIP JAMES II (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JAMES
Last Name:MOLLICA
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 BROADWAY AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-344-2000
Mailing Address - Fax:540-344-8573
Practice Address - Street 1:2502 BROADWAY AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-344-2000
Practice Address - Fax:540-344-8573
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
460498OtherACN GROUP
95316OtherSOUTHERN HEALTH
4279222OtherAETNA
VA241957OtherANTHEM
1867474OtherFIRST HEALTH
350038692OtherRAILROAD MEDICARE
252019OtherMAMSI ALLIANCE
460498OtherACN GROUP
252019OtherMAMSI ALLIANCE