Provider Demographics
NPI:1598753592
Name:ESTRADA, PHILIP RAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RAUL
Last Name:ESTRADA
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 1:400 38TH STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-766-8222
Mailing Address - Fax:201-766-8221
Practice Address - Street 1:400 38TH STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-766-8222
Practice Address - Fax:201-766-8221
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00695200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor