Provider Demographics
NPI:1407633217
Name:MESSINEO, PHILLIP (DC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:MESSINEO
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 1:777 CONCORD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1053
Mailing Address - Country:US
Mailing Address - Phone:646-842-1707
Mailing Address - Fax:
Practice Address - Street 1:777 CONCORD AVE STE 301
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1053
Practice Address - Country:US
Practice Address - Phone:646-842-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACHI3834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor