Provider Demographics
NPI:1134294481
Name:ISAACSON, PHILLIP LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:LEE
Last Name:ISAACSON
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:PO BOX 20
Mailing Address - Street 2:524 SOUTH 4TH STREET SUITE # 1
Mailing Address - City:EAGLE
Mailing Address - State:NE
Mailing Address - Zip Code:68347
Mailing Address - Country:US
Mailing Address - Phone:402-781-9200
Mailing Address - Fax:
Practice Address - Street 1:524 SOUTH 4TH STREET
Practice Address - Street 2:SUITE # 1
Practice Address - City:EAGLE
Practice Address - State:NE
Practice Address - Zip Code:68347
Practice Address - Country:US
Practice Address - Phone:402-781-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36608OtherBCBS
NE278627Medicare ID - Type Unspecified