Provider Demographics
NPI:1588656599
Name:BELLMAN, PHILIP ALEXANDER (DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALEXANDER
Last Name:BELLMAN
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 1:2141 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4644
Mailing Address - Country:US
Mailing Address - Phone:970-259-0565
Mailing Address - Fax:
Practice Address - Street 1:2141 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4644
Practice Address - Country:US
Practice Address - Phone:970-259-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1138111N00000X
CA10353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T60409Medicare UPIN
CO10223Medicare PIN