Provider Demographics
NPI:1568476570
Name:PHILIPOSE, ALVIN J (DC)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:J
Last Name:PHILIPOSE
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 1:7917 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4540
Mailing Address - Country:US
Mailing Address - Phone:405-848-7246
Mailing Address - Fax:405-842-8290
Practice Address - Street 1:7917 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4540
Practice Address - Country:US
Practice Address - Phone:405-848-7246
Practice Address - Fax:405-842-8290
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU87911Medicare UPIN