Provider Demographics
NPI:1407003304
Name:PHILLIP, MARIEL K
Entity Type:Individual
Prefix:DR
First Name:MARIEL
Middle Name:K
Last Name:PHILLIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 MINERAL AVE
Mailing Address - Street 2:UNIT 201
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1226
Mailing Address - Country:US
Mailing Address - Phone:401-952-0369
Mailing Address - Fax:401-475-6060
Practice Address - Street 1:1243 MINERAL SPRING AVE 201
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4636
Practice Address - Country:US
Practice Address - Phone:401-952-0369
Practice Address - Fax:401-475-6060
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor