Provider Demographics
NPI:1346243607
Name:BORUFF, PHILLIP W (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:W
Last Name:BORUFF
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 27
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-0027
Mailing Address - Country:US
Mailing Address - Phone:765-552-0004
Mailing Address - Fax:765-552-5246
Practice Address - Street 1:518 S ANDERSON ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2322
Practice Address - Country:US
Practice Address - Phone:765-552-0004
Practice Address - Fax:765-552-5246
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001111A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT86613Medicare UPIN
IN215700AMedicare ID - Type Unspecified