Provider Demographics
NPI:1134106669
Name:SANTIAGO, PHILIP T (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:T
Last Name:SANTIAGO
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 1:47 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9442
Mailing Address - Country:US
Mailing Address - Phone:973-334-3288
Mailing Address - Fax:
Practice Address - Street 1:75 N BEVERWYCK RD
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-2601
Practice Address - Country:US
Practice Address - Phone:973-335-5666
Practice Address - Fax:973-335-6187
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00181500111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ410824Medicare ID - Type Unspecified
T44887Medicare UPIN