Provider Demographics
NPI:1245400407
Name:SHEN, PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:SHEN
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 1:323 KEY PL
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1657
Mailing Address - Country:US
Mailing Address - Phone:718-640-7363
Mailing Address - Fax:
Practice Address - Street 1:323 KEY PL
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1657
Practice Address - Country:US
Practice Address - Phone:718-640-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor