Provider Demographics
NPI:1609053446
Name:PRINCETTA, PHILIP PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:PETER
Last Name:PRINCETTA
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 1:6236 CAMINO LARGO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3116
Mailing Address - Country:US
Mailing Address - Phone:619-231-1777
Mailing Address - Fax:619-231-1777
Practice Address - Street 1:1818 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2507
Practice Address - Country:US
Practice Address - Phone:619-231-1778
Practice Address - Fax:619-231-1777
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17420111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist