Provider Demographics
NPI:1396209813
Name:PHILLIPPI, CHRIS JON (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:JON
Last Name:PHILLIPPI
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FERN GLN
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5419
Mailing Address - Country:US
Mailing Address - Phone:808-333-6016
Mailing Address - Fax:
Practice Address - Street 1:7634 GIRARD AVE STE E
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4420
Practice Address - Country:US
Practice Address - Phone:808-333-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist