Provider Demographics
NPI:1073649752
Name:QUE, PHILIP ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:QUE
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 1:2259 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3355
Mailing Address - Country:US
Mailing Address - Phone:847-551-4410
Mailing Address - Fax:847-551-4412
Practice Address - Street 1:2259 RANDALL RD
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-3355
Practice Address - Country:US
Practice Address - Phone:847-551-4410
Practice Address - Fax:847-551-4412
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009292111N00000X
IL038.011044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor