Provider Demographics
NPI:1316044944
Name:PHILLIP, DEONARINE (D,C,)
Entity Type:Individual
Prefix:DR
First Name:DEONARINE
Middle Name:
Last Name:PHILLIP
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 WOODCRAFT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-4732
Mailing Address - Country:US
Mailing Address - Phone:210-213-1148
Mailing Address - Fax:
Practice Address - Street 1:5907 WOODCRAFT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-4732
Practice Address - Country:US
Practice Address - Phone:210-213-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor