Provider Demographics
NPI:1154303527
Name:PHILIP D RAKE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PHILIP D RAKE CHIROPRACTIC INC
Other - Org Name:RAKE CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-249-8326
Mailing Address - Street 1:2048 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1605
Mailing Address - Country:US
Mailing Address - Phone:818-249-8326
Mailing Address - Fax:818-352-1105
Practice Address - Street 1:2048 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1605
Practice Address - Country:US
Practice Address - Phone:818-249-8326
Practice Address - Fax:818-352-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15357111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty